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Author Topic: Switching to Isentress: Epzicom vs. Truvada  (Read 7525 times)

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Offline AboutToStart

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Switching to Isentress: Epzicom vs. Truvada
« on: September 16, 2010, 07:45:52 PM »
Hello Forum,

After being one year on Atripla I'm seriousely thinking of switching to Isentress. The Atripla had been working fine for me (U/D in 3 months and CD4 up from 280's to 440's). Mostly I'm feeling great. True I feel fatigued a lot, no energy sometimes, groggy on occasion, but that's about it. I can't even attribute all of that to Atripla necessarily for this can be due to the HIV infection itself or some unrelated sleeping problems I have. Still I'm thinking of trying to switch to Isentress and see if things gets better. If not, or if for some reason gets worse, can always switch back to ol' Atripla.

My ID Doc doesn't support my thoughts, saying Atripla works great for me and quoting the old redneck saying: 'if it ain't broke don't fix it'. I don't subscribe to that saying. Maybe it ain't "broke" as he says, but that doesn't mean there aren't any newer, just as good if not better (with less side effects) meds out there. So now I'm going to see another specialist to get a second opinion.

So here's my question: my nurse, whom I respect and appreciate dearly, recommended that if I'm gonna switch to Isentress - might as well ditch the Truvada as well and go with Epzicom+Isentress. She doesn't like the Truvada very much, saying it's prone to cause renal problems (she actually seen some people die of it though taken off Truvada but was too late..).

Anybody here on the combo Epzicom+Isentress? Any thoughts??

Thankk-you guyz :>
« Last Edit: September 16, 2010, 07:48:52 PM by AboutToStart »

Offline mewithu

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #1 on: September 16, 2010, 08:38:08 PM »
 I would take your nurses advice and dump the truvada but I take Isentress and it does make me fatigued. Although it did raise my Cd4 count. It works in a different way than the other drugs also. I think with time I am getting used to the fatigue and getting better with it. getting a little more energy every day. i think with all the stronger meds this is the case, taking a while to get use to them.
 I was on sustiva for a long time and never got used to the fatigue. I had to take a nap not to soon after taking sustiva to get any energy.
 
 Jerry:)
1997 is when I found out, being deathly ill. I had to go to the hospital due to extreme headache and fever. I fell coma like,  two months later weighing 95 pounds and in extreme pain and awoke to knowledge of Pancreatis, Cryptococcal Meningitis, Thrush,Severe Diarea,  Wasting, PCP pneumonia. No eating, only through tpn. Very sick, I was lucky I had good insurance with the company I worked for. I was in the hospital for three months that time. 
(2010 Now doing OK cd4=210  VL= < 75)
I have become resistant to many nukes and non nukes, Now on Reyataz, , Combivir. Working well for me not too many side effects.  I have the wasting syndrome, Fatigue  . Hard to deal with but believe it or not I have been through worse. Three Pulmonary Embolism's in my life. 2012 520 t's <20 V load

Offline Assurbanipal

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #2 on: September 16, 2010, 09:01:57 PM »
I was briefly on Isentress/Epzicom, but Isentress caused liver/muscle problems for me.  I'm still on Epzicom but with Prezista/Norvir now.

I dumped Truvada because of osteoporosis (tenofovir may have contributed to it).  Kidney issues aren't something I'd worry about a lot, because your doctor should be monitoring your kidneys in your quarterly labs (by testing your eGFR) and you can take action promptly if a problem pops up.  If you stick with Truvada you might want to get your vitamin D levels checked and take other steps to protect your bones (and make sure your labs include a eGFR)


Note, outside the US Epzicom is often referred to as Kivexa -- same drug just a different label.  If you look around you will see a few more on it.
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline Miss Philicia

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #3 on: September 16, 2010, 09:21:14 PM »
I don't see any reason to change from Truvada.
"Iíve slept with enough men to know that Iím not gay"

Offline Hellraiser

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #4 on: September 17, 2010, 07:25:24 AM »
I think the nurse is an idiot.  Truvada causes renal issues very very VERY slowly unless your kidneys were already damaged in some way, in which case Truvada is counter indicated I believe?  Any doctor worth his salt should be monitoring creatinine.  If the Truvada in your HAART is the issue, then Isentress/Epzicom, Sustiva/Epzicom, Selzentry/Epzicom, or Kaletra/Epzicom would all be choices to get away from it.  I honestly would stick with the Atripla unless you're just scared witless of the Truvada.  Can I reiterate that this nurse is an idiot?  Truvada is taken by a lot of positive people and is in EVERY firstline treatment choice because it is tolerated so well.

Offline Miss Philicia

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #5 on: September 17, 2010, 09:15:38 AM »
People should always keep in mind that Truvada is the most used HIV medication currently.  IIRC it's used in every first line preferred CDC guideline combo.  If it had all of these problems it would not be used so much.  Any problems that might arise in the overall patient population would have to be seen statistically against the huge numbers of people taking this medication.  I would even go further and say that the tenofovir/viread component, which has been on the market now for nine years, has probably seen the most use of any HIV med long term/volume used, but that's just speculation. I personally have been on tenofovir in some form now for those nine years or close to it as it was the first thing I switched to in an effort to halt my lipoatrophy issues.

I fail to understand why any newly diagnosed patient would take medication advice from a nurse. 
"Iíve slept with enough men to know that Iím not gay"

Offline newt

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #6 on: September 17, 2010, 11:56:51 AM »
Quote
I can't even attribute all of that to Atripla necessarily for this can be due to the HIV infection

Well, I would, cos with a supressed viral load the HIV infection is not really taxing you.

In terms of choice of drugs, what nearly everyone else has already said. Truvada.

- matt


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

Offline peteb

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #7 on: September 17, 2010, 04:34:58 PM »
I switched from Atripla to Epzicom/Isentess if  I really had my choice I loved Atripla

Offline eric48

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #8 on: September 17, 2010, 05:33:25 PM »
I am on Kivexa(aka epzicom), and If I needed a change, I would think the substitute would be Truvada. and vice versa...

Now, Truvada may affect your kidneys and Kivexa (because of ABC) may affect your liver.

ABC is not for everyone; you will need to take a genetic test first.

Also, the liver will have to be monitored closely... As you see ABC (hence Kivexa) has more IFs ; a recent study also said people like Truvada better.

IF, I underline IF, If you can take ABC, it has advantages of its own (saves your kidneys, goes more into the brain, lowers blood sugar and insulin resistance, increases HDL a bit)

because of the IFs, it is less popular than Truvada, but those who take it do not complain.

Since i take it, my blood sugar profile has improved so much so I will not have to take Metformin.   
Cheers

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline AboutToStart

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #9 on: September 18, 2010, 05:05:19 PM »
Thanks for y'all responses and inputs.

@eric - what are you taking the Epzicom with?
@peteb - how's your experience with epzicom/isentress been? why can't you be on atripla if you so prefer (resistance)?
@newt - I agree it's prolly the meds (not the virus) that make me fatigued/energyless. Perhaps it's actually the Truvada (not the Sastiva) that causes it. I guess the only way to find out is switch and see..
@Miss Philicia - I know Truvada is the most used drug today. Interesting enough, fatigue and energyless seem to be the most common complaint of HIV'ers on meds. Just a coincidence? All meds work well in handling the virus (Nukes, PIs, Integrase..), we just strive to find the ones with the least toll/damaging effects..
« Last Edit: September 18, 2010, 05:07:36 PM by AboutToStart »

Offline Miss Philicia

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #10 on: September 18, 2010, 05:16:09 PM »
Interesting enough, fatigue and energyless seem to be the most common complaint of HIV'ers on meds. Just a coincidence? All meds work well in handling the virus (Nukes, PIs, Integrase..), we just strive to find the ones with the least toll/damaging effects..

Do you realize that fatigue complaints with HIV pre-date both Truvada (and it's viread component)'s FDA approval, or in fact any HIV medications at all. 

Do you realize that just having depression issues can make you feel fatigued?  Have you been screened for that?
"Iíve slept with enough men to know that Iím not gay"

Offline eric48

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #11 on: September 19, 2010, 07:03:07 PM »


@eric - what are you taking the Epzicom with?


Epzicom + Viramune (see my - long - almost monologous thread about it in this section

If I need a switch I will most likely be I & K (or I&E in US), but here it is not yet approved for treatment naives. (would have been my first choice, but doc offered something strickingly different)

As far as SE are concerned I am doing OK...

Isentress goes less into the brain, or at least it was believed so untill recent studies tend to prove otherwise. Good penetration in all of your body is, I guess, a good thing to avoid mutations...

I may have to go another 30_40 years with the meds so I want to use up options sparingly

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline AboutToStart

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #12 on: October 15, 2010, 12:51:18 AM »
So I finally met with the head of my clinic and got the thumbs up to switch from atripla to truvada/isentress.

Regarding the truvada vs. epzicom question the head doctor said he recommends truvada for me. True some clinics prefer epzicom but according to him the difference is not apparent. Truvada might be  somewhat harder on the kidneys but epzicom is harder on the heart, so pick your organ... But his main arguement was: since I'm already on atripla for just over a year now, we already know I tolerate the truvada portion of my combo so why risk  switchin to epzicom?!??

So I guess I'll finish my last amount of atripla pills and start the new combo beginnign of next month.. pretty excited bout it.. By the way, I asked him if isentress has already been approved for once a day dosing. He said that not, but after 6-9 months of me doing fine on the new isentress combo he would consider switching me to once daily whether it gets FDA approved or not.. Is anybody here taking isentress once daily??
« Last Edit: October 15, 2010, 12:55:47 AM by AboutToStart »

Offline eric48

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #13 on: October 15, 2010, 04:28:27 AM »
He said that not, but after 6-9 months of me doing fine on the new isentress combo he would consider switching me to once daily whether it gets FDA approved or not.. Is anybody here taking isentress once daily??

Hi,

I am also interested in Isentress.

Let me cite this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770304/?tool=pubmed

and quote

---

An in vitro pharmacodynamic analysis suggested that once-daily dosing may be possible (95). This possibility is currently under investigation.

---

Me:

Unfortunately, that study has been performed and results presented at the conference in Vienna. You will have to look for it... (I have lost the link)

The outcome of the once-a-day dosing was FAILURE. Further analysis showed that the typology of patient (dependending on their resistance profile , if I remember well) could predict who will fail and who won't

The take home lesson for me is : once-daily Isentress is a No-No until approved or further research

I have asked my doc (who , by the way, is in favor of once a day Viramune, despite that it is not officially approved but proven safe by the experience of the millions of people taking it once a day after being UD for a while)
He said that for him once a day Raltegravir was a No-No

Isentress has a reasonably good potent index (but not extremely high) and a fairly good half life (time of residence in the body) (but not extremely high). Suppression is a combination of both.

Medium x medium does not make it super.

The manufacturer will most likely work out the pharmacokinetics for an extended release of Isentress (just like viramune is now developed as an extended release and has passed all tests)

Until this is done, seriously done, there is no scientific data to back the safety of once a day Raltegravir. There is scientific data against it.

Your pick...

Mine would be NO-NO

Cheers!  Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline Billy B

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #14 on: October 15, 2010, 10:47:35 AM »
My ID said that Isentress/Truvada was the correct combo for me because I have a sightly elevated liver panel but great kidneys.
Billy
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline ElZorro

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #15 on: October 18, 2010, 10:05:46 PM »
I think the nurse is an idiot.  Truvada causes renal issues very very VERY slowly unless your kidneys were already damaged in some way, in which case Truvada is counter indicated I believe?  Any doctor worth his salt should be monitoring creatinine.  If the Truvada in your HAART is the issue, then Isentress/Epzicom, Sustiva/Epzicom, Selzentry/Epzicom, or Kaletra/Epzicom would all be choices to get away from it.  I honestly would stick with the Atripla unless you're just scared witless of the Truvada.  Can I reiterate that this nurse is an idiot?  Truvada is taken by a lot of positive people and is in EVERY firstline treatment choice because it is tolerated so well.

I'm in the process of switching from Atripla to Truvada + Raltegravir. My understanding is that Truvada represents the two non-Sustiva components found in Atripla, no?

Offline Assurbanipal

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #16 on: October 20, 2010, 09:54:23 PM »
I'm in the process of switching from Atripla to Truvada + Raltegravir. My understanding is that Truvada represents the two non-Sustiva components found in Atripla, no?

Yes... or is that no? :)

... or, Correct! 

Truvada is the two non-Sustiva components found in Atripla
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline ElZorro

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #17 on: October 20, 2010, 10:25:14 PM »
 :D  thought so....thanks for the confirmation

Offline HowYouDoin

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #18 on: October 21, 2010, 08:06:00 AM »
I would get a second opinion. I am on Isentress (switched 5 months ago from Kaletra) and have been taking Truvada from the get go and have no had any kidney problems. Any drug that does liver damage I would consider in changing because you only have one liver as opposed to 2 kidneys if it comes to that.

I've had little to no side effects on Isentress and my cd4 % has risen although my CD counts went from 655 to 525   in the past 5 months but my doc said that is normal.

I didn't like the fact that your doctor told you that she has seen people die due to taking Truvada(renal failure). Yes, a doctor should "keep it real" but did she tell you that occurs in rare cases as well?

Offline AboutToStart

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #19 on: October 31, 2010, 11:19:28 AM »
Last day on Atripla today. AboutToStart Isentress+Truvada first thing tomorrow morning (Nov.1st). It's pretty exciting as starting meds for the first time  :P
« Last Edit: October 31, 2010, 11:25:45 AM by AboutToStart »

Offline eric48

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #20 on: October 31, 2010, 07:23:57 PM »
looking forward to read from your personnal experience...Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline AboutToStart

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #21 on: November 02, 2010, 10:10:42 AM »
looking forward to read from your personnal experience...Eric

This is unbelievable!!!

I never expected the switch to be so easy!!

I got up in the morning, had breakfast (what a change NOT having to worry about food anymore) then popped in the two pills (Truvada+Isentress), and... NOTHING!!! Not the slightest dizzy, groggy, headache, stomach upset, NADA!!! Maybe it's because I'm already a Meds' veteran (being 1 year on Atripla), or maybe just being lucky, but so far - really nothing!!!

Then I called Gilead to request a co-pay card for the Truvada (thank you Inchlingblue for the link) and went on my business as usual. The only thing is having to get used to taking pills twice in stead of once a day.

My only question: how y'all take your vitamins? My pharmacist told me it's not recommended taking them with meds.. in the past I used to take my vits in the morning and the Atripla at night. Now I take meds both in the morning and at night.. Do you just take the vitamins mid-day or in the morning together with the meds??

Offline surf18

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #22 on: November 02, 2010, 02:05:52 PM »
I'm on truvada / selzentry and I take all my supps and those 2 pills at the same time.

Offline ElZorro

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #23 on: November 02, 2010, 06:41:12 PM »
This is unbelievable!!!

I never expected the switch to be so easy!!

I got up in the morning, had breakfast (what a change NOT having to worry about food anymore) then popped in the two pills (Truvada+Isentress), and... NOTHING!!! Not the slightest dizzy, groggy, headache, stomach upset, NADA!!! Maybe it's because I'm already a Meds' veteran (being 1 year on Atripla), or maybe just being lucky, but so far - really nothing!!!

Then I called Gilead to request a co-pay card for the Truvada (thank you Inchlingblue for the link) and went on my business as usual. The only thing is having to get used to taking pills twice in stead of once a day.

My only question: how y'all take your vitamins? My pharmacist told me it's not recommended taking them with meds.. in the past I used to take my vits in the morning and the Atripla at night. Now I take meds both in the morning and at night.. Do you just take the vitamins mid-day or in the morning together with the meds??

That's wonderful news! Glad it's working out for you!  ;)

Offline Inchlingblue

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #24 on: November 03, 2010, 10:18:15 AM »

My only question: how y'all take your vitamins? My pharmacist told me it's not recommended taking them with meds.. in the past I used to take my vits in the morning and the Atripla at night. Now I take meds both in the morning and at night.. Do you just take the vitamins mid-day or in the morning together with the meds??

There are people on here who take their vitamins and other supplements along with meds but I agree with your pharmacist and prefer to take them at a different time.

I'm also on I/T so I take my supplements during lunchtime.

By the way, Isentress also has a copay program but it only kicks in at copays above $50 (or maybe it's $30.?). I use it during January and February which is when I have high copays until I meet the deductible.

Offline Miss Philicia

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #25 on: November 03, 2010, 02:43:43 PM »
We're well into our 13th year of HAART, so if the case was that one shouldn't take a multi-vitamin along with their HIV meds we'd know about it.  Kindly provide some external links to back up this.
"Iíve slept with enough men to know that Iím not gay"

Offline Inchlingblue

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #26 on: November 03, 2010, 03:10:03 PM »
We're well into our 13th year of HAART, so if the case was that one shouldn't take a multi-vitamin along with their HIV meds we'd know about it.  Kindly provide some external links to back up this.

This is deja vu all over again.

A long time ago I posted a link from a doctor or pharmacist recommending a 2-hour interval between HIV meds and vitamins/supplements. Many pharmacists recommend this with meds in general not just HIV meds.

I can't find that link but I did find this one:

http://forums.poz.com/index.php?topic=32978.msg406491#msg406491


Many vitamins, especially the water-soluble ones are probably fine and some supplements are probably fine but why be playing a guessing game? For me it's easier to take the HIV meds alone and take the vitamins/supplements separately.

Offline Miss Philicia

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #27 on: November 03, 2010, 03:49:57 PM »
One link -- impressive.  My larger point was if this was an issue, as opposed to forum fear mongering, we'd all be getting instructions from our physicians as well as warnings on pharmaceutical bottles.  This is a non-issue.
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Offline eric48

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #28 on: November 03, 2010, 05:56:25 PM »
Actually, I have move my timing so that to be 2 hours away from food as well.

After food, I get an insulin peak and I fear it might interfere with the meds...

I am doing this just in case and until I get UD...

Cheers

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline AboutToStart

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Re: Switching to Isentress: Epzicom vs. Truvada
« Reply #29 on: November 03, 2010, 11:42:28 PM »
For now (day 3 on I/T) I'm taking my vits/supps when I get up in the morning (around 7-8am). Then take my I/T combo around 11am, to keep 12hr interval till my night second Isent dose (which I take at 23pm before bed).

Weired observation after switching to I/T: I sleep LESS good then on Atripla. True, the vivd dreams are gone, but I don't sleep as tight as before. It might be just a coincedence so far (couple of nights) but I think the Atripla used to knock me out and made me sleep like a log. Perhaps a lil more time needed to get adjusted..

 


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