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Author Topic: Atripla resistance  (Read 5137 times)

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Offline xman

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Atripla resistance
« on: August 28, 2010, 12:59:48 PM »
If you take Atripla for 12 days and then stop it for 4 days, how risky is it to develop resistance to one of the drugs?
sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

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we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline phildinftlaudy

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Re: Atripla resistance
« Reply #1 on: August 28, 2010, 01:10:46 PM »
If you take Atripla for 12 days and then stop it for 4 days, how risky is it to develop resistance to one of the drugs?
Probably not one of the best moves - but since everyone's body is different - a person would have to a) check with doctor and ultimately, b) see their labs

I know that there are differing lifespans for the effectiveness of each drug component in Atripla - which other members have shared more detail on in other posts - the longer time frame between doses, the less effectiveness and of course the more chances of resistance developing -

I don't know if anyone would be able to give an actual accurate response to your question as there are variables - I guess the best response is that it is a once a day everyday medication for a reason - and going outside of those parameters isn't recommended obviously.

Hope this helps in some way...
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Hellraiser

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Re: Atripla resistance
« Reply #2 on: August 28, 2010, 02:48:55 PM »
This is a bad idea.

Offline peteb

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Re: Atripla resistance
« Reply #3 on: August 28, 2010, 03:36:11 PM »
Ditto bad Idea

Offline Miss Philicia

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Re: Atripla resistance
« Reply #4 on: August 28, 2010, 04:06:34 PM »
Why do you want to do this?
"Iíve slept with enough men to know that Iím not gay"

Offline newt

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Re: Atripla resistance
« Reply #5 on: August 28, 2010, 04:22:54 PM »
No-one can tell you for sure.

It is probably not zero but somewhere close to zero if viral load is less than 50 copies and it's 4 days not 5.

If you have only been on Atripla for 12 days, and your viral load is above 50 copies, then the risk of complete resistance to efavirenz, one of the 3 drugs in Atripla, may be as high as 50%. Higher viral load = greater risk. There is probably very little chance of resistance developing to the other two drugs in Atripla, these being tenofovir and FTC.

The "correct" way to stop efavirenz-containing combinations is to take some other ARVS for 1-2 weeks. It takes 5-21 days for efavirenz to finally leave your body. Having a moderate level of efavirenz left in your bloodstream  means that the virus can mutate because the drug is present in sufficient quantity to stimulate the virus to evolve but not enough to kill it, hence the strategy of using other drugs for a short time to suppress the virus while the efavirenz washes out.

- Matt
"The object is to be a well patient, not a good patient"

Offline Inchlingblue

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Re: Atripla resistance
« Reply #6 on: August 28, 2010, 04:42:40 PM »
As Newt mentions, the resistance concern here is specifically with Sustiva (efavirenz) since it has a longer half life than the other two drugs.

I would say that resistance is more likely to happen if there is a viral load present. If a person is undetectable it can still happen of course but it's possible that the Sustiva might be out of your system before the virus comes back.

This scenario (Sustiva resistance due to taking Atripla for about a week) happened to Tednlou2, when he was initially hospitalized and the hospital irresponsibly put him on Atripla temporarily.
« Last Edit: August 28, 2010, 04:51:16 PM by Inchlingblue »

Offline xman

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Re: Atripla resistance
« Reply #7 on: August 28, 2010, 08:38:41 PM »
Why do you want to do this?

My doc told me to stop Atripla because I developed a rash after 10 days. Today is the second day and yesterday I was in his clinic for further examinations. I'm waiting for the blood exams which will also be tested for syphilis since the symptoms are very similar. I'm afraid of developing resistance. Perhaps I need to stop anyway Atripla because of the Efavirenz so a resistance to it would not be so bad.

What makes me quite angry is the fact that aside from the rash I tollerated Atripla very well. I guess that if I definitely need to stop Atripla I have to take a PI regimen with Norvir. I'm not so happy about this because of side effects.
sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

http://www.aidspolicyproject.org/petition_for_the_nih

we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline Inchlingblue

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Re: Atripla resistance
« Reply #8 on: August 28, 2010, 09:22:14 PM »
Perhaps I need to stop anyway Atripla because of the Efavirenz so a resistance to it would not be so bad.
 

The thing is this would also give you resistance to other NNRTIs, not only efavirenz.

Can't you get a new combo and just start taking it without having an interruption in treatment?

Offline ElZorro

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Re: Atripla resistance
« Reply #9 on: August 29, 2010, 02:41:13 AM »
My doc told me to stop Atripla because I developed a rash after 10 days. Today is the second day and yesterday I was in his clinic for further examinations. I'm waiting for the blood exams which will also be tested for syphilis since the symptoms are very similar. I'm afraid of developing resistance. Perhaps I need to stop anyway Atripla because of the Efavirenz so a resistance to it would not be so bad.

What makes me quite angry is the fact that aside from the rash I tollerated Atripla very well. I guess that if I definitely need to stop Atripla I have to take a PI regimen with Norvir. I'm not so happy about this because of side effects.

I'm not a Dr, but I was told that a rash was a possible side effect but was usually temporary. Thankfully, I didn't have that issue. Have you considered a second opinion?  Especially, if your current doctor is advising you to stop cold turkey.  That is definitely something my doctors have advised is a serious no-no because of the resistance issues everyone else has alluded to.
« Last Edit: August 29, 2010, 02:43:29 AM by ElZorro »

Offline Miss Philicia

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Re: Atripla resistance
« Reply #10 on: August 29, 2010, 09:59:42 AM »
I guess that if I definitely need to stop Atripla I have to take a PI regimen with Norvir. I'm not so happy about this because of side effects.

Which PI are you referring to and what side effect potential specifically?
"Iíve slept with enough men to know that Iím not gay"

Offline xman

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Re: Atripla resistance
« Reply #11 on: August 29, 2010, 10:33:18 AM »
Which PI are you referring to and what side effect potential specifically?

Well I know that the Prezista/Norvir or Reyataz/Norvir combos are the preferred ones. I'm concerned about initial nausea and vomiting and also for the long term toxicities which are a bit higher when compared with Atripla.

I had absolutely no side effects with Atripla and then after 10 days this rash. It seems it was serious enough to convince the doctor stopping therapy. It's a kind of allergic reaction. I have rash also in the feets and hands, inside and outside.
« Last Edit: August 29, 2010, 10:39:28 AM by xman »
sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

http://www.aidspolicyproject.org/petition_for_the_nih

we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline Miss Philicia

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Re: Atripla resistance
« Reply #12 on: August 29, 2010, 11:00:11 AM »
long term toxicities

such as what and with what frequency in patients?
"Iíve slept with enough men to know that Iím not gay"

Offline Inchlingblue

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Re: Atripla resistance
« Reply #13 on: August 29, 2010, 11:13:35 AM »
Prezista and Reyataz are PIs that have good side effects and toxicity profiles. Every medication will have some toxicity but these are not so bad in the scheme of things and given the alternative.

You could also just switch to Isentress/Truvada (assuming it's available in Eataly).

If you have not already stopped Atripla it's best to switch to the new combo without a break in therapy.

I always thought that the Atripla rash usually goes away in a few days with most people.

Offline xman

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Re: Atripla resistance
« Reply #14 on: August 29, 2010, 11:13:48 AM »
such as what and with what frequency in patients?

Norvir is devastating on high doses. It is linked with heart and cardiovascular risk, diabetis, pancreatitis, gastronintestinal and lipo issues. It is the Norvir that concerns me more. I know that Reyataz and Prezista are good drugs but they need to be combined with the Norvir. I was reading that in Europe some docs are increasing the doses of Reyataz to avoid the Norvir. It's time for it to be put off the market.
« Last Edit: August 29, 2010, 11:16:18 AM by xman »
sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

http://www.aidspolicyproject.org/petition_for_the_nih

we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline Hellraiser

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Re: Atripla resistance
« Reply #15 on: August 29, 2010, 11:33:33 AM »
I had absolutely no side effects with Atripla and then after 10 days this rash. It seems it was serious enough to convince the doctor stopping therapy. It's a kind of allergic reaction. I have rash also in the feets and hands, inside and outside.

This is the standard and definitive Atripla rash it presents in 10-20 days and usually lasts for two to three weeks.  Unless you had something crazy out of the ordinary or the rash never resolved you should not have been taken off of the treatment.

Offline Miss Philicia

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Re: Atripla resistance
« Reply #16 on: August 29, 2010, 11:40:44 AM »
Norvir is devastating on high doses. It is linked with heart and cardiovascular risk, diabetis, pancreatitis, gastronintestinal and lipo issues. It is the Norvir that concerns me more.

except Norvir is only now used as a booster for other PIs and it's a very small, 100mg dose -- please learn what you're talking about if you're going to attempt to discuss things.  As far as it being "put off the market" what are you smoking?  Even the new Gilead cobicistat booster which will appear on the market next year is basically the same chemical compound, they're just choosing not to brand it as such.

Much ado about nothing.
« Last Edit: August 29, 2010, 11:43:56 AM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline xman

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Re: Atripla resistance
« Reply #17 on: August 29, 2010, 11:58:57 AM »
except Norvir is only now used as a booster for other PIs and it's a very small, 100mg dose -- please learn what you're talking about if you're going to attempt to discuss things.  As far as it being "put off the market" what are you smoking?  Even the new Gilead cobicistat booster which will appear on the market next year is basically the same chemical compound, they're just choosing not to brand it as such.

Much ado about nothing.

Are you a medic or HIV specialist? I guess not. If many docs here are trying to avoid Norvir for the reasons I mentioned there must be a valid reason. Americans have a more conservative approach. In Europe they try alternative ways to minimize side effects and costs on the national health system. Norvir is expensive and potentially toxic and the cumulative effect even at small doses is still remarkable. Not to mention the corporate ethics of Abbott, the producer of Norvir.

And just to clarify I don't smoke.

sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

http://www.aidspolicyproject.org/petition_for_the_nih

we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline Miss Philicia

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Re: Atripla resistance
« Reply #18 on: August 29, 2010, 12:13:04 PM »
In Europe they try alternative ways

care to be specific?
"Iíve slept with enough men to know that Iím not gay"

Offline newt

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Re: Atripla resistance
« Reply #19 on: August 29, 2010, 04:17:40 PM »
Norvir at 100mg a day is prob no worse than any other ARV. Ethics, well yes, Abbott has a lot to answer for. Your doc has handled your rash badly, and not given you options ie ie stop, change or manage through the rash. Plus, certainly in the UK, and prob most of west Europe, Isentress (raltegravir) should be an option in this circumstance, if you decide to switch.

- matt
« Last Edit: August 29, 2010, 04:19:43 PM by newt »
"The object is to be a well patient, not a good patient"

 


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