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Author Topic: Changing Regimen To Gain Weight ?  (Read 2036 times)

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Offline rd

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  • Posts: 9
Changing Regimen To Gain Weight ?
« on: December 19, 2011, 01:34:53 PM »
I have been on a steady regimen of Isentress + Ziagen + Epivir + Viread for quite some time and am doing well except for losing a lot of leg and butt muscle.   The doctor said that three of my drugs cause lipo side effects.   He offered to switch me to Prezista, Norvir, and Maranroc (selentry ?) and told me to go home and read up on them and think about it.   

Questions for this group:

Is the new regimen going to be as good as the one I have and enable me to gain some weight or at least stop losing weight ? 

Will it have good CNS penetration and durability in maintaining undetectable ?   

What short or long term side effects are most likely ?

Any help or advice would be really greatly appreciated. 

Offline newt

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  • the one and original newt
Re: Changing Regimen To Gain Weight ?
« Reply #1 on: December 19, 2011, 03:29:34 PM »
Hello

I don't like your docs prescribing

1. Ziagen + Epivir + Viread is 1 drug from the NRTI class too much. Dropping either the Ziagen or Viread will still leave a sufficient combo and may be enough to help. Ziagen and Viread are not recommended for use together in most situations.

2. Maraviroc requires a special test (tropism test) before using to see if it will work.

3. There is no strong evidence changing combo will help you gain muscle. Lipoatrophy is loss of fat not muscle. Are you sure it's muscle not fat you are losing? Your doc can test for this. It may not even be meds related.

4. If you really want a combo with the fewest NRTIs (ie Ziagen, Epivir or Viread) - the class of drugs which may rarely be related to muscle loss - Isentress + boosted Prezista + Epivir may be a good option.

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

Offline rd

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Re: Changing Regimen To Gain Weight ?
« Reply #2 on: December 19, 2011, 03:40:23 PM »
Matt,  It's both fat and muscle really.   Years ago I used things like DDI, AZT, and Efaviranz.  I don't think I ever really recovered my face or butt and legs after that.  The ziagen, epivir, and viread I'm told are what's causing the problem now.  Of the three, which is the least lipo friendly and could be dropped ?  So far I'm not really comfortable with everything I'm reading about the new PI regimen he's proposing.

Offline newt

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Re: Changing Regimen To Gain Weight ?
« Reply #3 on: December 19, 2011, 03:54:25 PM »
Prezista is not like the old PIs. I agree the product info is scarey but it's currently my doc's fave drug side effects wise after Isentress.

The NRTIs in order of friendliness are:

Epivir
Ziagen
Viread

It should be possible to find a combo with just one of these in.

I get the AZT etc thing. Therefore I see merit in exploring a non-NRTI combo but Maraviroc/boosted Prezista I don't like especially with long-standing HIV (Maraviroc perhaps not so good in these situations).

Isentress on paper and so far in studies is the most metabolism friendly drug, no lipid effects or mitochondrial involvement recorded. But, I note, a few reports of muscle weakness on this med, and it's kinda new, there's still time for it's bad side to come out.

So maybe Maraviroc is therefore the least worst option (subject to tropism test).

Sorry, being a bit vague on the Maraviroc.

But 3 nukes, bad I think.

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

Offline rd

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Re: Changing Regimen To Gain Weight ?
« Reply #4 on: January 24, 2012, 10:46:30 AM »
So the viread is the highest contributor to lipoatropy ?  If I am undectectable and dropped the Viread out of the combo would everything still stay good ?   I'm not sure how these drugs overlap one another.

Offline Billy B

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Re: Changing Regimen To Gain Weight ?
« Reply #5 on: January 24, 2012, 11:27:40 AM »
Hello Newt
I was wondering why you did not suggest using Truvada since it is the used so often with Isentress?
Peace,
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 newt

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  • the one and original newt
Re: Changing Regimen To Gain Weight ?
« Reply #6 on: January 24, 2012, 01:44:24 PM »
Quote
So the viread is the highest contributor to lipoatropy ?

This is not what I am saying, I am saying in terms of least overall side effects in a 1,2 3 order (abacavir allergy aside) it seems to be Epivir, Ziagen, Viread. All these drugs are from the nuke class of drugs. None of these individual drugs have been strongly associated with lipoatrophy in studies, but nukes as a class have, and maybe taking 3 is not good for your metabolism. 3 is hardly ever necessary or recommended.

As it's both fat and muscle that's going it seems to me perhaps its a metabolism phenomenon rather than classic drug-related lipoatrophy. I'd want a bunch of tests and work-ups, starting with kidney function, cortisol and a few others. A DEXA scan can usually settle the question of is it/isn't it lipo?

This is not to say the muscle/fat loss isn't drug related, but the cause needs investigation to inform options for a possible solution. I assume your doc did some tests, and didn't just have a chat in the office?

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

Offline rd

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  • Posts: 9
Re: Changing Regimen To Gain Weight ?
« Reply #7 on: January 24, 2012, 03:35:36 PM »
I haven't had any of the tests you recommended but will ask for them.  My confidence is not really too high with my current doc because he was going to offer the meraviroc without a tropism test, and I had to actually ask for my testosterone to be checked last time and the results came back 250 for total which is sub optimal. That would have been completely missed if I didn't ask for it.    It's almost like you have to become educated about HIV medicine yourself and then tell the doc what to do for you.

Offline newt

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  • the one and original newt
Re: Changing Regimen To Gain Weight ?
« Reply #8 on: January 24, 2012, 03:45:36 PM »
Quote
I had to actually ask for my testosterone to be checked last time and the results came back 250 for total which is sub optimal. That would have been completely missed if I didn't ask for it.    It's almost like you have to become educated about HIV medicine yourself and then tell the doc what to do for you.

Indeed it is and this is one thing that could be important here. Doc needs a boot in the brain perhaps. Hope this gets sorted.

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

Offline denb45

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  • "1987 Classic Old School POZ+"
Re: Changing Regimen To Gain Weight ?
« Reply #9 on: January 24, 2012, 03:46:15 PM »
  It's almost like you have to become educated about HIV medicine yourself and then tell the doc what to do for you.

Well your the one that's suppose to be in charge of your own health care, most Doctors I know hate it when your not very pro-active w/ teh AIDS and other related health issues....the squeaky wheel always get's the grease  ;)
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline buginme2

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  • Posts: 3,128
Re: Changing Regimen To Gain Weight ?
« Reply #10 on: January 24, 2012, 08:25:16 PM »
It's almost like you have to become educated about HIV medicine yourself and then tell the doc what to do for you.

Ain't that the truth

 


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