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Author Topic: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada  (Read 4997 times)

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Offline pozoz

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  • Posts: 70
Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« on: March 03, 2011, 05:15:07 PM »
I'm switching from my current regimen which includes 2 PI's, to one with none.

The reasons are the Verimune blood/brain barrier thing, and also minor annoyances with GI issues (bloating, diarrhea and raised billirubin levels (not harmful but a bit unsightly) causing jaundice.

I've looked around a little and have not seen much about a regimen with only Truvada and Verimune.

Currently I am doing my "lead in" dose of Viramune (1 a day for 14 days, then 2 a day) whilst still taking the 2 PI's, so effectively I'm currently on "quadruple therapy".

After my liver function tests hopefully come back clear in a week, the plan is to stop the PI's after 2 weeks and continue with only Truvada and Verimune. Doc said the 2 Viramune a day can be taken together at the same time, although I read it was only being considered at the moment and not officially "approved" yet.

Also I did a drug interaction which advised not to co administer these drugs, but was assured by my doctor it was okay while we do the regimen changeover.

Anyone heard of a regimen such as this? Were you successful? Any thoughts? Good or bad? I'm just a bit curious, as I had pretty good numbers with the previous regimen and don't want to go backwards..

Thanks....
Seroconverted Aug 2008
Tested Pos      May 2009
May 09 CD4 544 19%   VL 22K
Aug 09 CD4 514  19% VL 25K
Dec 09 CD4 510  20% VL 32K
June10 CD4 502  20% VL 36K
July 5th,10 Start Truvada  Reyataz Norvir July 30  CD4 360  21% VL 339
Oct  22 CD4 459  27% VL 191
Jan 2011CD4 561 33% VL U/D <40
Feb  Add Verimune lead in dose to start switch to Verimune/Truvada  
Mar 17 Viramune x2 + Truvada. Stop PIs   
Apr 29     CD4 528 33% VL U/D
July 2011 CD4 440  %?  VL U/D
Sept 2011CD4 620  %?   VL U/D
Dec 2011 CD4 531 31% VL 224
Jan 2012  CD4 576 36% VL U/D
May 2012 CD4 504 36% U/D (start Viramune XR
July 2012 576 (36%) (test request due to XR issues)
Feb  2013 629  (? %) U/D
July  2013 608 38%.   U/D
Jan  14.    576  36%.   UD

Offline surf18

  • Member
  • Posts: 525
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #1 on: March 03, 2011, 07:01:17 PM »
that was my first regimen back in the summer time. i was on it for about 3 weeks, week two came and while i was still on the one a day, i broke out in a heinous rash/hives.head to toe. had to miss work and everything. it lasted for days,still to this day have some left. i went off it obviously. but i had no other side effects. now on truvada/selzentry

Offline eric48

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  • Posts: 1,173
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #2 on: March 03, 2011, 07:12:53 PM »
Hi,

just an impression, not even an opinion: I think that this strategy is SMART.

I have asked my doc why a strategy like yours is not standard procedure. He ignored my question, as it is not relevant to my case (I started with V & K). Mine is quite close to yours and so far i am very happy with it.

http://forums.poz.com/index.php?topic=33062.0

The Good viramune penetration has drawn a bit more attention recently and is a reason why some lead doctors, who, in my area, were notorious for being anti NVP and pro-PI are making a remarkable U-turn.

My doc mentioned this with a smile because he says he was being mocked by fellow docs for prescribing (still) viramune and is happy to see it back as more fashionable.

Good viramune penetration was the deciding factor for putting me on Viramune in the first place

recent study shows that Viramune users have a 80% chance to reach VL down to one after being UD for a while.

Viramune is not for everyone though, some people can't stand it.

I hope you will and be successfull; you are an almost pill buddy to me and this is very welcome, because I was feeling a bit lonely LOL

Cheers

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 2 months

Offline pozoz

  • Member
  • Posts: 70
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #3 on: March 05, 2011, 01:22:14 AM »
Definetely on the lookout for any signs or rash..Day 3 now and seems to be going well..

Did the rash suddenly just appear one day or was it a gradual thing?

Eric I've been reading with interest your progress on Viramune, I also hear it is coming back "in fashion" by some doctors. I look forward to following your progress and wish you all the best with it.

Some random thoughts... Veramune has been around since 1996 and is about ten times cheaper that some of the newer drugs..irrelevant yes, just something I noted.

Also the guidelines state it is not reccomended for people with CD4 counts over 400 (for men I think, for women it might be lower) my impressiion is there is a higher risk of side effects such as the dreaded rash and liver toxicity issues.

My CD4 is higher than this, but again was reassured that we should still try it.

Some of the other things considered for switching were minor LDL/HDL issues with PI's, constant mild GI issues and as I said before the yellow eyes occasionally, and moderate fatigue which I am totally unsure if that's med related.

These were certainly not debilitatiing, and overall the Truvada/Reyataz/Norvir combo was tolerated quite well, I'm not knocking it at all and think it was a great first regimen for me. If the rash develops or LFT comes back with bad news, I'll go back to T/R/N or maybe consider something else. Any suggestions?

Be well...... 8)



Seroconverted Aug 2008
Tested Pos      May 2009
May 09 CD4 544 19%   VL 22K
Aug 09 CD4 514  19% VL 25K
Dec 09 CD4 510  20% VL 32K
June10 CD4 502  20% VL 36K
July 5th,10 Start Truvada  Reyataz Norvir July 30  CD4 360  21% VL 339
Oct  22 CD4 459  27% VL 191
Jan 2011CD4 561 33% VL U/D <40
Feb  Add Verimune lead in dose to start switch to Verimune/Truvada  
Mar 17 Viramune x2 + Truvada. Stop PIs   
Apr 29     CD4 528 33% VL U/D
July 2011 CD4 440  %?  VL U/D
Sept 2011CD4 620  %?   VL U/D
Dec 2011 CD4 531 31% VL 224
Jan 2012  CD4 576 36% VL U/D
May 2012 CD4 504 36% U/D (start Viramune XR
July 2012 576 (36%) (test request due to XR issues)
Feb  2013 629  (? %) U/D
July  2013 608 38%.   U/D
Jan  14.    576  36%.   UD

Offline surf18

  • Member
  • Posts: 525
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #4 on: March 05, 2011, 08:04:41 AM »
i had started with a cd of around 227.
anyways, work up on a sunday all normal. then worked out and noticed some blotchyness on me. in random spots,then tru the day i became spotted and it got worse and worse and then i went to bed i had the hives to go with the rash.it was terrible so bad i had to miss work for a few days.so yea it just came out of no where.i had no other sides with it. well some pain in my right side belly on the night before the rash.

Offline eric48

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  • Posts: 1,173
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #5 on: March 05, 2011, 05:52:34 PM »
Hi,

My understanding is that Viramune rash can be a very rough experience. There is a risk and no predictors...

There may be some genetics or whatever, but, as of today, no causative factor has been identified.

The tricky one is that, while there is a risk, a risk that should not be taken lightly, those who have been lucky enough to withstand it are very happy with it.

If it were not for those very adverse effect at the initiation, I think it would be rated amoung the most favored.

For those who have had the adverse efefct, I can not do more that offer my sympathy, and be happy for them that there are other options.

Those who can have it will most certainly get the unique benefits: it is, as of today, the only FDA approved drug (including non HIV drugs) that has a proven effect of increasing HDL significantly.

All you can do is be hopefull. If you get the rash, go to your doctor, do not stop just on your own.

There are 2 (may be a bit more) drugs notorious for a very adverse rash/allergic reaction at initiation: nevirapine and Abacavir, and, mind, you, I take both !

And, see... I am doing fine, so I hope the same for you.

You will have to be on the look out for 2 -3 months max.

Only thing I can recommand is drink a lot of water and restrict liver intense activities (alcohol) for a while. My Doc said it is pointless. But, my views, is, if the benefits are real, then it is worth putting all potentially advserse conditions aside.

Me, I just find it easy enough to take, the pill is small, can be swallowed without food or water (the kivexa pill that I take is so huge that I need a mouthfull of water).

Important reminder:
*******************

the 400 CD4 cut off is ONLY for traitment naives. it DOES NOT apply  to treatment experienced people, so this should be the LEAST of your worries.

It is not approved for once daily because the manufacturer has not applied for FDA approval. But all studies and doc/patients experience support that it can be taken once a day (2 pills):

http://www.ncbi.nlm.nih.gov/pubmed/19214120

The manufacturer has developped an extended release version that has successfully passed the trials and they have (recently) applied for FDA' approval: at stake is that they hope to sell the XR version at a higher price...

The trial that relates most to your case is this one:

http://www.ncbi.nlm.nih.gov/pubmed/20149984

I am sure you will find it interesting !

Also, on the top of my head (I am not librarian, so don't kill me if I am wrong) , I remember for reading the detailed trial reports (not just the abstract) that twice daily was (slightly) superior to once daily in TREATMENT NAIVE (hence the labelling recommendation), but, the same trial also show a slightly better
outcome in the once daily arm for TREATMENT EXPERIENCED.

My doctor (who is a long timer NVP prescriber) had made it clear from day one, that, should I succeed on this treatment, he would allow once-a-day .

When I asked him last week (month 8 into treatment) :
when will I be allowed to take the pills together ?

he was surprised.

he pulled up my last prescription (at month 6) and it was already on there ! ! I simply had not noticed...

I wish I had, since the once-a-day thing, which I did not thought as very important to me, turned out to be very beneficial as it has already (in less than a week) significantly reduced my stress/anxiety/depression.

I can not say more than this : I strongly hope you will pass these 1 to 10 first weeks with success !

Cheers

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 2 months

Offline pozoz

  • Member
  • Posts: 70
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #6 on: March 15, 2011, 07:34:00 PM »
Okay, 2 week "lead in dose" of 1x Viramune x14 days done, no problems. LFT all clear.

Start 1x Truvada and 2x Viramune (all at once) tomorrow and stop the PI's.

2nd LFT in next 2 weeks.

So far so good.   ;D ;D

Eric I PM'd you if you didn't get it,if not, Thanks heaps for the detailed info and links.... ;)
Seroconverted Aug 2008
Tested Pos      May 2009
May 09 CD4 544 19%   VL 22K
Aug 09 CD4 514  19% VL 25K
Dec 09 CD4 510  20% VL 32K
June10 CD4 502  20% VL 36K
July 5th,10 Start Truvada  Reyataz Norvir July 30  CD4 360  21% VL 339
Oct  22 CD4 459  27% VL 191
Jan 2011CD4 561 33% VL U/D <40
Feb  Add Verimune lead in dose to start switch to Verimune/Truvada  
Mar 17 Viramune x2 + Truvada. Stop PIs   
Apr 29     CD4 528 33% VL U/D
July 2011 CD4 440  %?  VL U/D
Sept 2011CD4 620  %?   VL U/D
Dec 2011 CD4 531 31% VL 224
Jan 2012  CD4 576 36% VL U/D
May 2012 CD4 504 36% U/D (start Viramune XR
July 2012 576 (36%) (test request due to XR issues)
Feb  2013 629  (? %) U/D
July  2013 608 38%.   U/D
Jan  14.    576  36%.   UD

Offline eric48

  • Member
  • Posts: 1,173
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #7 on: March 15, 2011, 08:58:58 PM »
Hi,

I did get the PM ! Thanks for the thanks ... Been on the road with limited access recently and a lot to catch up with...

I had not realized that you were already into the process. Time flies!

Since I take 2 drugs that may have very severe adverse reaction at initiation, I do not recall what is the extend of the risky period for each one....

That you've passed the 2 weeks lead in with success is very reassuring. It was instituted because the adverse reactions that it has helped avoid were not reversible.

On the top of my head, and do not quote me on that, from now on, should an adverse reaction appear, it would be reversible.

You need be on the look out and be carefull for a 1-2 months.

I had a very sudden burning skin feeling that occurred on one day at week 6, dissipated after one day and was on a hot summer day.

Not the (dreaded) viramune rash...

You just want to be carefull, let your body adjust, drink lots of water, no stress, keep calm (but do not hesitate to go to your Doc if ant thing wrong shows up)

For those who could not withstand the drug, it has been a distressfull experience (which is why some docs are reluctant about it). It can be devastating, but, here, again, should that ever happen, you have other options.

For those who could, it is as easy to take as aspirin.

Seems to me that it is either one or the other. No grey area.

Then your doc will have to check that you liver works OK.

You're already out of the vermilion red (danger) zone. and now in a standard red for 2-3 weeks. Then, if you pass that, the risk is downgraded to orange for another month, and so forth.

Keep track of your cholesterol and other biomakers, because, if everything goes as we hope, then, chances are that you are going to be very happy with what you'll see.

keep us posted!

it is a very interesting switch strategy (when it is successfull, of course...) and your experience will help others

Thanks for the good news.

I keep my fingers crossed for you

Cheers!

Eric
« Last Edit: March 15, 2011, 09:01:11 PM by eric48 »
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 2 months

Offline eric48

  • Member
  • Posts: 1,173
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #8 on: March 31, 2011, 04:13:08 PM »
Hi,

Once-a-day (QD) vs. Twice-daily (BID) Nevirapine as Simplification in PI-Treated Patients after 2 mos. of BID Induction.

http://www.ncbi.nlm.nih.gov/pubmed/21443516

is an interesting article ...

Patients were switched from a PI to NVP 200 mg BID for 2 months, and then randomized...
(of note, the trial experts have considered it safer to start with twice a day for 2 months and then, evaluate the change)

it concludes:The switch to NVP may be safely pursued with a Qnce Daily schedule.

this other one confirms that is is an interesting strategy:

http://www.ncbi.nlm.nih.gov/pubmed/18651856
Switching from suppressive protease inhibitor-based regimens to nevirapine-based regimens: a meta-analysis of randomized controlled trials.



Eric
« Last Edit: March 31, 2011, 04:33:27 PM by eric48 »
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 2 months

Offline eric48

  • Member
  • Posts: 1,173
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #9 on: April 04, 2011, 06:27:22 PM »
I earlier said that my gut feeling is that the strategy is SMART.

Stamp the virus hard (with a PI) then switch to a combo that suits your profile best (could be another PI , I&T, etc.)

I had suggested this to my doc who ignored it...

but this below kind of goes along same thinking:

http://www.aidsmeds.com/articles/hiv_treatment_switch_1667_20181.shtml

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 2 months

Offline pozoz

  • Member
  • Posts: 70
Re: Switcjing from Truvada/Reyataz/Norvir to Viramune/Truvada
« Reply #10 on: April 08, 2011, 10:16:09 PM »
Just a update: Doing extremely well on Viramune+Truvada, all 3pills at dinner, or around dinner time...love the fact that there are no food requirements like before with the PI Reyataz.

Eyes are whiter, no GI issues like before (even though they were very mild, but still annoying)

Went for LFT and routine bloods including Vitamin D, VL, CD4 etc but was deferred because I had a slight chest infection, Doc said pointless to run tests as they will most likely be out due to the illness...so deferred for another 2 weeks..no sign of any liver toxicity (ie jaundice) ...he did mention my second LFT showed a VERY SLIGHT elevation of something (I forgot) on the LFT, but nothing to worry about, so I won't.

Will update profile with new numbers when I get them, but am loving this non PI based regime, hopefully the numbers to come will confirm this is a regimen worth considering...Be well...Cheers..
Seroconverted Aug 2008
Tested Pos      May 2009
May 09 CD4 544 19%   VL 22K
Aug 09 CD4 514  19% VL 25K
Dec 09 CD4 510  20% VL 32K
June10 CD4 502  20% VL 36K
July 5th,10 Start Truvada  Reyataz Norvir July 30  CD4 360  21% VL 339
Oct  22 CD4 459  27% VL 191
Jan 2011CD4 561 33% VL U/D <40
Feb  Add Verimune lead in dose to start switch to Verimune/Truvada  
Mar 17 Viramune x2 + Truvada. Stop PIs   
Apr 29     CD4 528 33% VL U/D
July 2011 CD4 440  %?  VL U/D
Sept 2011CD4 620  %?   VL U/D
Dec 2011 CD4 531 31% VL 224
Jan 2012  CD4 576 36% VL U/D
May 2012 CD4 504 36% U/D (start Viramune XR
July 2012 576 (36%) (test request due to XR issues)
Feb  2013 629  (? %) U/D
July  2013 608 38%.   U/D
Jan  14.    576  36%.   UD

 


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