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Author Topic: Isentress once a day  (Read 2616 times)

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Offline jb1973

  • Member
  • Posts: 68
  • To thine ownself be true
Isentress once a day
« on: August 14, 2012, 06:03:08 PM »
Anyone taking this once a day?  I'm starting I/T on Friday and my doctor has told me that I can take the isentress once a day. She said that my VL was low enough and I would be ok. I know the study that finished last year or before had only an 83% success rate so I guess I'm confused as to why she would want me to dose only once a day?  My VL is around 10k and cd4 has always been above 500. I told her I had no problem with having to take it twice a day, but she said we could talk about it on Friday when I visit again to pick up meds.
??Infected - 08-09??
3/3/11-tested POZ
3/18/11 - CD4-534 VL-6,600
6/24/11 - CD4-642 VL-10,800
10/11 - CD4-580 33% VL-9,900
1/12 - CD4-602 ?% VL-9,700
3/12 - CD4-552 27% VL=10,684
8/12 - cd4-550 24% VL=9.865
Started Isentress/Truvada
10/12- CD4-613 31% VL=UD

Offline newt

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  • the one and original newt
Re: Isentress once a day
« Reply #1 on: August 14, 2012, 08:30:50 PM »
If your viral load now is after being on meds for a while is still 10k, 1 x day vs 2 x day, it's beside the point. You need to get you viral load below 50 copies for a few months before Isentress 1 x day is even a discussion.

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

Offline jb1973

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  • Posts: 68
  • To thine ownself be true
Re: Isentress once a day
« Reply #2 on: August 14, 2012, 09:02:33 PM »
Thanks for the reply!  I've never been on meds. The isentress and truvada are my first, but, I get the message. I was just wondering if anyone else had been in a similar situation. I guess I'll tell her on Friday I prefer to take them twice a day and maybe ask why she thought I could do once a day?
??Infected - 08-09??
3/3/11-tested POZ
3/18/11 - CD4-534 VL-6,600
6/24/11 - CD4-642 VL-10,800
10/11 - CD4-580 33% VL-9,900
1/12 - CD4-602 ?% VL-9,700
3/12 - CD4-552 27% VL=10,684
8/12 - cd4-550 24% VL=9.865
Started Isentress/Truvada
10/12- CD4-613 31% VL=UD

Offline newt

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  • Posts: 3,887
  • the one and original newt
Re: Isentress once a day
« Reply #3 on: August 15, 2012, 03:09:39 AM »
The best possible chance for success with Isentress is to start on it 2 x day. This is how the drug is meant to be used. Your first time on treatment is most important, best to get it as right as possible.

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

Offline Ann

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    • Num is sum qui mentiar tibi?
Re: Isentress once a day
« Reply #4 on: August 15, 2012, 05:20:51 AM »
My hiv doctor is also an hiv pharmacologist/med research scientist and we had this discussion about once-a-day Isentress dosing. He's adamantly against it under any circumstances. He says it's just not worth taking the chance of treatment failure when there are other once-a-day combos out there that have been proven to be effective.

One of the reasons he's so against it is because it leaves you with virtually no window period for taking your meds - ie you would be risking failure if you occasionally took it a couple hours late, unlike most other combos. He's fully aware that sometimes life gets in the way of taking meds at the same exact time every day.

He thinks it's a great combo when taken twice a day, but only twice a day. I trust his knowledge and experience.
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 eric48

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  • Posts: 1,202
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Isentress once a day
« Reply #5 on: August 15, 2012, 09:23:37 AM »
He's adamantly against it under any circumstances.

Same here, my doc said it is a NO-NO

There is a clinical trial (I forgot the name) which people were expecting to prove that 1x day is OK, but it proved the exact contrary

Hope this helps

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 jb1973

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  • Posts: 68
  • To thine ownself be true
Re: Isentress once a day
« Reply #6 on: August 15, 2012, 05:39:17 PM »
Thanks for the advice.  I plan on insisting to take twice a day, as reccommended.   I will at least ask her why she was thinking I could take once a day.

??Infected - 08-09??
3/3/11-tested POZ
3/18/11 - CD4-534 VL-6,600
6/24/11 - CD4-642 VL-10,800
10/11 - CD4-580 33% VL-9,900
1/12 - CD4-602 ?% VL-9,700
3/12 - CD4-552 27% VL=10,684
8/12 - cd4-550 24% VL=9.865
Started Isentress/Truvada
10/12- CD4-613 31% VL=UD

Offline Ann

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  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Isentress once a day
« Reply #7 on: August 16, 2012, 03:34:20 AM »
Sounds like a good plan, JB. Be a dear and let us know what her reasoning is and what she has to say about what other people's doctors have said. (including mine who has had more hiv pharmacology papers published in respected medical journals than some people  have had hot dinners! ;D )
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 eric48

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  • Posts: 1,202
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Isentress once a day
« Reply #8 on: August 16, 2012, 05:57:34 PM »
Hi,

On top of that there is nothing wrong in following the pills manufacturer's recommendation (twice daily) rather than one's doc.

That been said, I did find the article I was looking for:
http://www.ncbi.nlm.nih.gov/pubmed/22430964
Pharmacokinetics and pharmacodynamics of once-daily versus twice-daily raltegravir in treatment-naive HIV-infected patients.
(
Please see also the first report:
http://www.ncbi.nlm.nih.gov/pubmed/21933752
)

While the abstract does confirm that the virologic failure was higher in the once daily arm, it also says:

Failure to achieve an HIV RNA level of <50 copies/ml appeared predominantly at high baseline HIV RNA levels in both treatment arms

I think I remember there was a post trial re-analysis that did confirm that for some patients profiles, there was no much difference between once daily and twice daily.

Since RAL is my plan B and I do not recall that I fall within the happy few that can take once daily, I did not mark up the discussion. So this is out of my memory.
If I remember well this was one post-trial re-analysis poster at a conference (Wien?) - you would have to dig it up

But if there is a clinical trial that supports that in your case QD is equivalent to BID, and your doc has enough confidence AND you are sure to have alternatives in case RAL fails you, then it may be worth considering it.

I personnally take my viramune off label once daily (instead of manufacturer's recommended twice daily) and this because
- my doc recomends it
- there is a clinical trial that supports it (for treatment experienced, but after 6 months, one is considered, treatment experienced)
- I have alternative combo available

I would think it is safer to consider off-label once <50 has been reached

Convninience of once daily should not be underestimated. I was twice daily for 6 months then was changed to once daily : it makes my life really much easier
(although if one is taking twice daily , missing one dose has less impact than if you missed a 24 h dose...)

This matter should be considered carefully, and discussed openly with doc.

Hope this helps

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 Ann

  • Administrator
  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Isentress once a day
« Reply #9 on: August 17, 2012, 05:37:46 AM »

Convninience of once daily should not be underestimated. I was twice daily for 6 months then was changed to once daily : it makes my life really much easier


Which begs the question - why mess around with taking any of these meds "once-a-day off-label" when there are other, easily tolerated proven once-a-day combos available? Chancing possible resistance - and possibly to a whole class of drugs, not just one single drug - just seems foolish when you don't have to go down that road.
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 jb1973

  • Member
  • Posts: 68
  • To thine ownself be true
Re: Isentress once a day
« Reply #10 on: August 17, 2012, 12:11:58 PM »
Well, I met with my doctor this morning to pick up meds and so she could go over dosing etc.  I just told her that I wanted to take the Isentress twice a day and she didnt even argue.  Honestly, i forgot to ask her directly why we were going to dose once a day, but, she did mention during the conversation that once I was UD for awhile we could revisit the once a day dosing idea.  I'm not sure how sold i am on that idea but will address it if it comes up again.  Thank you all for your replies and advice!

Tomorrow I will swallow my first pills.
??Infected - 08-09??
3/3/11-tested POZ
3/18/11 - CD4-534 VL-6,600
6/24/11 - CD4-642 VL-10,800
10/11 - CD4-580 33% VL-9,900
1/12 - CD4-602 ?% VL-9,700
3/12 - CD4-552 27% VL=10,684
8/12 - cd4-550 24% VL=9.865
Started Isentress/Truvada
10/12- CD4-613 31% VL=UD

Offline vaguesbleues

  • Member
  • Posts: 93
Re: Isentress once a day
« Reply #11 on: August 17, 2012, 06:55:11 PM »
Good luck with the regimen!  :) 
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

 


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