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Author Topic: Atripla and high cholesterol numbers + reversing VL trend  (Read 1547 times)

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Offline NY2011

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  • Posts: 140
Atripla and high cholesterol numbers + reversing VL trend
« on: April 23, 2012, 09:18:10 PM »
Good news is that my t cells went from 750 to 1,221 in four months, and that my liver enzyme #'s are within range. 

Of concern is that my viral load has gone from undetectable (<50) to 140 within a month.  It may be a blip, as the doctor mentioned, but it has me concerned.

Bad news is that my cholesterol numbers are very high for a 39 year old active male: Total cholesterol is 276 and triglyceride is 194.

It's been suggested that switching from sustiva to Isentress is better for addressing elevated liver enzymes, but what about cholesterol?  What about increasing viral loads?  Has anyone switched from Atripla to a different regimen to control these factors?


« Last Edit: April 23, 2012, 09:25:56 PM by NY2011 »
10/26/2011 - SEROCONVERSION (hi fever+rash)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   ( 49%)
03/26/2014 - CD4=1,050 VL= ud

Offline drewm

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Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #1 on: April 23, 2012, 09:26:16 PM »
Atripla controlled my numbers but made my triglycerides go up, so I am on meds for triglycerides. Throwing Atripla under the bus is not an option IMHO.
MAY 2010
VL>500,000 CD4>8

JUNE 2010 STARTED ATRIPLA

DEC 2010
VL>30 CD4>323

Atripla. Valtrex, Trilipix, Fluoxotine

Offline NY2011

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  • Posts: 140
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #2 on: April 23, 2012, 09:42:25 PM »
I'm not losing sight of truvada and sustiva being life-saving and life-sustaining drugs.  I completely respect the science and research, and i am grateful to the core that they exist.  I'm just asking around to possibly fine-tune my own experience. 

Having said that, I've read that statins with HIv meds increases risk for kidney damage, myopathy, bone density loss, and a host of other problems. 

10/26/2011 - SEROCONVERSION (hi fever+rash)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   ( 49%)
03/26/2014 - CD4=1,050 VL= ud

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #3 on: April 24, 2012, 07:27:40 AM »
One result is NOT a "trend". It's a blip. Only a few years ago 140 would have been undetectable, so relax. I'll bet you $140 that you're UD again on your next set of labs.

About your triglycerides - have you considered "fine tuning" your diet first before messing with your meds? Sometimes the simple solution is the best, and easiest.
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Offline NY2011

  • Member
  • Posts: 140
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #4 on: April 24, 2012, 07:28:13 PM »
 yeah. good advice.
« Last Edit: April 24, 2012, 07:32:50 PM by NY2011 »
10/26/2011 - SEROCONVERSION (hi fever+rash)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   ( 49%)
03/26/2014 - CD4=1,050 VL= ud

Offline eric48

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  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #5 on: April 25, 2012, 05:13:51 PM »
Hi,

There is a paper that describe a model for blips. It is called the asymmetric model.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657607/?tool=pubmed

In this model, to make a long story short the course of events are the following:

1- an 'intruder' (or recurring, reactivating infection) requires a immune response. (The usual suspects that do require CD4 T cells are those opportunistic infections, that are otherwise harmless, (unless the CD4 Tcell pool is severely depleted): candida, CMV, varicella-zoster virus , etc.

2- under the condition that the immune response requires CD4 (not all immune response require CD4 T cells) the CD4 T cells pool expands thousand folds (in localized area)

3- that clonal expansion include HIV free CD4 Tcells as well a some few HIV harboring restive CD4 Tcells. The proportion of HIV harboring CD4's is unchanged but their total number gets a sudden (and, localized) boost 

4- thanks to this numeric expansion, CD4 T cells (as helpers) help effector (killer) CD8 T cells perform their immune defensive attack. they win: the war's over.

5- helper CD4s are not needed anymore and kindly invited to leave the crime scene (in other words, to die...)

6- as they die, they leave some free RNA behind them, which is what your VL test picks up.

sudden expansion of CD4s, relaxing of the tension, VL as left overs: business as usual: nothing to worry about. (the patient does not even sense that an immune response took place)

Me, too, I would put a bet that you VL is going to go back to <50
Taking a bit more risk, and supposing that your CD4 % had not changed much, I would also bet that those CD4 count will get back to their usual number as well.

Hope this helps

Eric
« Last Edit: April 25, 2012, 05:21:17 PM by eric48 »

Offline newt

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  • the one and original newt
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #6 on: April 25, 2012, 06:17:36 PM »
Viral loads tests that count down to 20 tend to give more blips ie results over 20 and under 200 (ta, Roche).

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

Offline NY2011

  • Member
  • Posts: 140
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #7 on: April 25, 2012, 11:53:00 PM »
Eric,

Excellent.  Thanks for the post.  About 2 weeks before visiting the doctor, I wasn't feeling so hot, and had 24 hr fever/chills some stomach issues. The fever went away, but the stomach issues stuck around for a while.  I just didnt feel right, so I booked an appointment. I was tested for CMV, results were negative, but the spike in CD4 makes sense, to fight infection of some sort, along with the RNA detritus left behind, which may have been dead CD4.  Again, excellent.  Thanks for sharing.
« Last Edit: April 26, 2012, 06:18:17 AM by NY2011 »
10/26/2011 - SEROCONVERSION (hi fever+rash)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   ( 49%)
03/26/2014 - CD4=1,050 VL= ud

Offline eric48

  • Member
  • Posts: 1,110
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #8 on: April 26, 2012, 04:58:07 PM »
recent report:
http://www.ncbi.nlm.nih.gov/pubmed/22530816.1

HIV-1 low-level viraemia assessed with 3 commercial real-time PCR assays show high variability.

also support the measurement outlier option

take home lesson: nothing to worry about

On the HIV associated additional cardiovascular risk:
there is a growing number of papers published by scientists (reminder : scientific article does not equate to truth, science evolves, also...) that CMV infection may  be a major co-factor and may be the underlying reason for this additional risk:

See:
http://www.ncbi.nlm.nih.gov/pubmed/22492856
Cytomegalovirus IgG antibody is associated with subclinical carotid artery disease among HIV-infected women.

and
http://www.ncbi.nlm.nih.gov/pubmed/22492854
CMV and Immunological Aging: The Real Driver of HIV and Heart Disease?


No yet fully established 'science', but, may help the CMV neg / Hiv + patient feel more comfortable and not jump to the hardware store to buy a defibrillator ;-)

usual life style intervention: smoking cessation, exercise, weight control remain recommended regardless of this or that serostatus

Hope this helps.
Cheers
Eric

Offline eric48

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  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #9 on: April 26, 2012, 05:21:19 PM »
Back to the OP:

Has anyone switched from Atripla to a different regimen to control these factors?

As far as I am concerned I did not 'switch' , but did take into account the better HDL outcome when deciding to choose NVP (aka viramune) rather than EFV (aka Sustiva)

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

NVP is the only known FDA approved medication (as it is a CETP inhibitor) which significantly increases the proportion of HDL (good) cholesterol.
Another CETP inhibitor is under development by Merck and is bound to become a blockbuster if it gets approved.

Worked on me...

Seems to be an easy enough switch and you coud easily switch back if Viramune is not good for you (some people experience a rash and have to stop)
Liver numbers outcome under Viramune, are on the other hand a matter of concern and require monitoring.

Here again, as far as I am concerned : no problemo

eric

Offline NY2011

  • Member
  • Posts: 140
Re: Atripla and high cholesterol numbers + reversing VL trend
« Reply #10 on: April 26, 2012, 10:12:01 PM »
Eric, my genotype shows a resistance to R211K (AZT?) and G333E (dual resistance to zidovudine and lamivudine), and a probable resistance to L10I (minor protease) and L63F (protease inhibitor?).  No resistance to any NNRTI's, including  NVP ( Viramune), so that's good news.

« Last Edit: April 28, 2012, 09:55:57 AM by NY2011 »
10/26/2011 - SEROCONVERSION (hi fever+rash)
10/31/2011 - CD4= 154  VL>500,000 
10/31/2011 - started on Truvada+Prezista+Norvir
12/14/2011 - CD4= 750 VL=6412 (45%)
01/27/2012 - switched to Atripla
04/23/2012 - CD4=1,221 VL= 140  (47%)
06/22/2012 - CD4=1,224 VL= ud    (49%)
12/18/2012 - CD4=1,031 VL= ud    (51%)
09/16/2013 - CD4=1,151 VL= ud   ( 49%)
03/26/2014 - CD4=1,050 VL= ud

 


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