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Author Topic: Goodbye Atripla, Hello Viramune+Truvada  (Read 2666 times)

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Offline northernguy

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  • Posts: 1,347
Goodbye Atripla, Hello Viramune+Truvada
« on: June 17, 2012, 01:45:43 PM »
I finally asked my doc to put me on something else.  Atripla has messed with my sleep too much (crazy dreams, can't get back to sleep).  Neither my doc nor the pharmacist seemed concerned about my cd nadir not having reached more than 400.

Any tips I should know?  Will start first week of July.
Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

Offline surf18

  • Member
  • Posts: 525
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #1 on: June 17, 2012, 02:07:40 PM »
Keep an eye out for the dreaded verimune rash.

Offline surf18

  • Member
  • Posts: 525
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #2 on: June 17, 2012, 02:15:30 PM »
Keep an eye out for the dreaded verimune rash.

Offline alberche

  • Member
  • Posts: 213
  • a distancia del mundo incierto, saludo mi suerte
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #3 on: June 17, 2012, 06:02:28 PM »
And, what about suggesting Intellence  (instead of Viramune) to your doctor?

I'm on Intellence (etravirine) + Kivexa (Abacavir + 3TC) and it is going OK. I take all pills of both meds once a day, altogether.

Intellence seems to have the same efficacy than Sustiva (Efavirenz) but much lesser side effects (no rash, no cognitive or sleep issues, etc). It is also more safe than Viramune and you have no restrictions as per regards of CD4 counts.

Six years ago my first treatment was Sustiva + Truvada (Atripla did not exist yet) and I had to quit Sustiva one month later due to an allergic reaction, also had the bizarre dreams issues during the first days. 

My doc, at that point, changed the combo to Truvada + Reyataz + Norvir (IPs), and this combo with protease inhibitors did very well to me. Two years ago, when Intellence (Etravirine) was released, my doc changed again to try this new NNRTI, and preserve IPs for a future, and it's also doing OK for me.

Finally, last year, I had to quit also Truvada due to bone mass loss, and replace it by Kivexa (Abacavir + 3TC).

The only difference I would mention as per regards to IPs is that from time to time I feel a bit more tired. In the positive side, mi lipids and glucose in blood test have improved with no needs of an special care as per regards of the kind of foods I eat, and also my stomach is working much better.

I hope you will do OK,

Hugs :-)
love is blindness...  a wonderful song!

Offline eric48

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  • Posts: 1,202
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #4 on: June 17, 2012, 06:41:55 PM »
Neither my doc nor the pharmacist seemed concerned about my cd nadir not having reached more than 400.

Hi,

Male with CD4 > 400 are not spposed to take Viramune (I did at CD4 at ca. 500, though)
BUT this restriction is ONLY valid for treatment naive and is not applicable to treatment experienced.

Since you are treatment experienced, this 400 threshold does not need to be considered.

Viramune is a bit more risky, especially in case of initial treatment. much less so as a switch to option

Hope this helps clarify 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 joemutt

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  • Posts: 1,042
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #5 on: June 17, 2012, 09:06:02 PM »
If you do not get the , very rarely occurring,  rash, during the first 2 to 4 weeks, then this is a very good drug. I have been on it for years + truvada with excellent results : cd 4 950 t0 1450 range, lipids normal. All the best  :) .

Online buginme2

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  • Posts: 3,221
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #6 on: June 17, 2012, 11:06:15 PM »
Why did your doctor recommend Viramune and not Complera (if sticking with an nnrti) or something else? 

I understand the desire to ditch the Atripla.  Viramune just seems a like a pain in the ass, there's the rash risk for those with higher cd4 counts plus this recent review of data showing that there is a "significantly higher risk of death for those taking Nevirapine compared to Effavirenz"



http://aids-clinical-care.jwatch.org/cgi/content/full/2012/521/1

Don't be fancy, just get dancey

Offline northernguy

  • Member
  • Posts: 1,347
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #7 on: June 18, 2012, 12:40:18 AM »
Why did your doctor recommend Viramune and not Complera (if sticking with an nnrti) or something else? 

I understand the desire to ditch the Atripla.  Viramune just seems a like a pain in the ass, there's the rash risk for those with higher cd4 counts plus this recent review of data showing that there is a "significantly higher risk of death for those taking Nevirapine compared to Effavirenz"

http://aids-clinical-care.jwatch.org/cgi/content/full/2012/521/1

There's a couple issues with Complera:
1. I'm on pantoprazole, a proton pump inhibitor, which makes Complera less effective
2. The gov't in BC covers the total cost of HIV meds, and therefore hasn't added Complera to the formulary for cost reasons (probably keeping an eye on Viramune on Sustiva going generic soon)

As to Intellence my doc seemed less keen on it, maybe keeping it as a resistance option, and there was also something about the pill size?

Viramune was/is very widely used here, so they have a lot of experience with it.
Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

Online buginme2

  • Member
  • Posts: 3,221
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #8 on: June 18, 2012, 02:27:57 AM »
That makes sense.  I would save Intellence.  No need to go that route yet.

If the Viramune doesn't work you could also do a PI or Isentress, and the Quad should be approved before the end of the year. 
Don't be fancy, just get dancey

Offline northernguy

  • Member
  • Posts: 1,347
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #9 on: June 20, 2012, 01:09:35 AM »
Well, got the pills this morning, start tomorrow.  When the pharmacist saw I was switching, they said "good".  I get the feeling a lot of them don't think the "once a day" aspect is worth the side effects.

A couple things I didn't realize:
-Sustiva can stay in your system up to six weeks!
-The liver issues are rarer one you've already been on one of the drugs in the same class.  The pharmacist had seen only one liver reaction in 12 years, which is a relief because this is what worried me most about the drug.

Wish me luck.
Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

Offline ajm_ldn

  • Member
  • Posts: 69
Re: Goodbye Atripla, Hello Viramune+Truvada
« Reply #10 on: June 22, 2012, 08:39:18 PM »
All the best with it! I have always been on Truvada, but I dropped Sustiva for Viramune five years ago after two months feeling awful on Sustiva (tired and spaced out). Since then I've had ZERO side effects and been totally undetectable.

I hope you do well too. :)

 


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