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Author Topic: Resistance questions and stuff  (Read 1109 times)

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Offline songs06

  • Member
  • Posts: 114
Resistance questions and stuff
« on: July 14, 2012, 03:46:37 PM »
I've started my treatment with Truvada and Kaletra just 5 days ago. For now, i have no problems. No diarrhea, no nausea. I was kinda nervous because of Kaletra but only side effect i've seen is fatigue. I am feeling like i ve ran a marathon all the time. But i know my body will get used to it really fast.

My question is, one of the guys in turkey, who once progressed to  AIDS and started treatment after that, told me he is also on Truvada and Kaletra but he wants to change as soon as possible. (after his CD4 gets up to 350.) He wants to use Efavirenz, which i really don't like as a drug because of psychologic side effects. (and one my friends had really bad dermatological side effects.) So i told him truvada and kaletra combo is nice, suppresses viral load fast, and fly your CD4s. But he told me even if you use Truvada+Kaletra combo right on time, and even with successful committed treatment, there is a high risk of resistance. This what his ID told him i guess.

I always guess as long as i use my drugs well, there is no need to afraid of resistance. So i searched for an article or something about resistance rate of succesfull treatment. But i couldn't find anything. (i'm bad at searching on pubmed :))

My real questions are:
1-Do you know resistance rates of unsuccessful treatments. I ve read one's goal must be %90. Even if you couldn't use your drugs for one or 2 days, there is very low chance of resistance.

2-Do you know is there any difference between regimens? For example, Truvada+Kaletra combo has higher risk of resistance? Or efaviranz (Stocrin) have less risk? I mean even you do not forget one dose of your drugs, is there a risk of resistance in 5 years or more?

So i started my drugs, and happy about it, but i also afraid of resistance. I would be happy to see some numbers about this topic. Thank you.
18.03.2012 - infected.
14.04.2012 - first positive elisa - UD western blot
30.04.2012 - western blot confirmation positive
03.05.2012 - first lab- CD4: 256   VL: 2.3 M
01.06.2012 - sec lab- CD4: 390 (end of ARS)
01.07.2012 - third lab- CD4: 388 VL: 150.000
11.07.2012 - Started Truvada + Kaletra
04.08.2012 - CD4: 401 VL: 3800
30.09.2012 - CD4: 510 VL: 709
04.01.2013 - CD4: 650 VL: UD! (aka 20)
01.04.2013 - CD4: 460 VL: UD
09.2013 - CD4: 510
02.2014 - CD4: 490

Offline newt

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  • the one and original newt
Re: Resistance questions and stuff
« Reply #1 on: July 14, 2012, 04:04:57 PM »
The risk of resistance is lower with protease inhibitors including Kaletra than with NNRTIs like efavirenz.

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

Offline Common_ground

  • Member
  • Posts: 288
Re: Resistance questions and stuff
« Reply #2 on: July 14, 2012, 05:05:58 PM »
What makes a regimen fail once reaching UD?

Apart from the obvious things like adherence and absorbing the meds.

Higher risk to build resistance if you have been "struggling" with getting UD?
 
2011 May - Neg.
2012 June CD4:205, 16% VL:2676 Start Truvada/Stocrin
2012 July  CD4:234, 18% VL:88
2012 Sep  CD4:238, 17% VL:UD
2013 Feb  CD4:257, 24% VL:UD -viramune/truvada
2013 May CD4:276, 26% VL:UD

Offline eric48

  • Member
  • Posts: 1,010
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Resistance questions and stuff
« Reply #3 on: July 14, 2012, 06:13:20 PM »
What makes a regimen fail once reaching UD?

Apart from the obvious things like adherence and absorbing the meds.

Higher risk to build resistance if you have been "struggling" with getting UD?

Once you reach UD and remain adherent chances that resistance and virologic failure is so slim that you should not even worry about that

Which is why docs insists on adherence.

Of course, the prerequisite is to reach <50 ....

Even in countries with good access to meds only 50% of people are UD. But that includes people who had a long and complicated treatment history (I mean here the very first meds...) , who are not adherent and who drop treatment.

Strangely enough, even in countries where socialized care provides meds for free, people droping treatment may be has high as 10% ...

UD + adherent : that is the goal...

Hope this helps eric

Online Miss Philicia

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  • celebrity poster, faker & poser
Re: Resistance questions and stuff
« Reply #4 on: July 14, 2012, 06:21:51 PM »
Even if it failed why wring your hands? You folks that are newly diagnosed act like you're on the very last possible treatment available.
"Iíve slept with enough men to know that Iím not gay"

Offline songs06

  • Member
  • Posts: 114
Re: Resistance questions and stuff
« Reply #5 on: July 15, 2012, 04:16:59 AM »
Thanks for the answer,

So i wonder what is the rate of resistance risk of RTI+PI combination, even with committed treatment with no dose missing. Is there an article about this topic?

Dear Miss Philicia,
Even though i think, i should learn this kind of things because i am positive now, also i live in Turkey at moment. This means, in this country, there are only few PI and RTI. We don't have Isentress or not even one a day combo Atripla. Pretty much everything we have are kind of old drugs. Health Ministry doesn't interested in treatment of HIV. So if my virus got resistant to the drugs available, i am pretty fucked. :) That's why lots of HIV patients quite anxious about resistance. Our ID Docs trying to get new drugs. My ID doc told me maybe Isentress come to Turkey like in 5 years :) Things work slower in countries with less patients.
18.03.2012 - infected.
14.04.2012 - first positive elisa - UD western blot
30.04.2012 - western blot confirmation positive
03.05.2012 - first lab- CD4: 256   VL: 2.3 M
01.06.2012 - sec lab- CD4: 390 (end of ARS)
01.07.2012 - third lab- CD4: 388 VL: 150.000
11.07.2012 - Started Truvada + Kaletra
04.08.2012 - CD4: 401 VL: 3800
30.09.2012 - CD4: 510 VL: 709
04.01.2013 - CD4: 650 VL: UD! (aka 20)
01.04.2013 - CD4: 460 VL: UD
09.2013 - CD4: 510
02.2014 - CD4: 490

Offline Ann

  • Administrator
  • Member
  • Posts: 27,947
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Resistance questions and stuff
« Reply #6 on: July 15, 2012, 08:10:49 AM »
Even if it failed why wring your hands? You folks that are newly diagnosed act like you're on the very last possible treatment available.

PLWA in Turkey can face treatment interruptions not of their own making, so yeah, I can see where Songs might be worried about resistance issues. A document published in 2006 - Vulnerability assessment of people living with HIV (PLHIV) in Turkey (pdf) - outlines the many problems he faces.

Some of the issues may have been addressed in the intervening six years since publication but I have a feeling that access to treatment hasn't improved all that much, certainly no where near on par with the improvements people like you and I in the US and UK have seen in those same six years.

Songs, can you read through that document and let us know if - or how much - things have improved since 2006?

Provided you manage to have a steady supply of your combo and provided you take it every day, the chances of you becoming resistant are fairly remote. Fingers crossed here that your supply is stable.

Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Rockin

  • Member
  • Posts: 491
Re: Resistance questions and stuff
« Reply #7 on: July 17, 2012, 10:10:51 AM »
Once you reach UD and remain adherent chances that resistance and virologic failure is so slim that you should not even worry about that

Which is why docs insists on adherence.

Of course, the prerequisite is to reach <50 ....

Even in countries with good access to meds only 50% of people are UD. But that includes people who had a long and complicated treatment history (I mean here the very first meds...) , who are not adherent and who drop treatment.

Strangely enough, even in countries where socialized care provides meds for free, people droping treatment may be has high as 10% ...

UD + adherent : that is the goal...

Hope this helps eric

I wonder what prevents people from adhering to the treatment...what makes people simply stop taking their medicine? Aren't these people scared to get sick? I understand someone not wanting to start treatment in the first place but starting and stopping out of nowhere? I do not understand this at all. 

Offline newt

  • Member
  • Posts: 3,868
  • the one and original newt
Re: Resistance questions and stuff
« Reply #8 on: July 17, 2012, 11:42:38 AM »
Quote
I wonder what prevents people from adhering to the treatment

Insurance?...

...and ADHD, depression, susbtance misuse problems, a bunch of other conditions, being homeless, kids being ill, weddings, being in love, the acid being too good, your handbag being stolen, flood damage, bereavement, just being a beautiful day and having forgot you are HIV+, ER admissions, getting a crush on a denialist, religion, side effects etc etc etc etc etc

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

Offline Rockin

  • Member
  • Posts: 491
Re: Resistance questions and stuff
« Reply #9 on: July 17, 2012, 03:58:07 PM »
Insurance?...

...and ADHD, depression, susbtance misuse problems, a bunch of other conditions, being homeless, kids being ill, weddings, being in love, the acid being too good, your handbag being stolen, flood damage, bereavement, just being a beautiful day and having forgot you are HIV+, ER admissions, getting a crush on a denialist, religion, side effects etc etc etc etc etc

- matt


LOL weddings?

 


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