Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Shall we switch to Stribild?

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Miss Philicia:
So then how can you, in your own words, recommend a switch? ::) You've not been on Isentress so you have no way to compare the two, or to make a compelling case to the OP. Basically the most you can say is "I like pie."

mecch:
Yes it fine to say you like your combo.  My purpose was not to shut you down. 

But the OP is asking about switching, and switching off one he/she already likes and has no side effects.

Was only saying, as Miss P has now explained as well, how can you recommend a switch... ?  Ok?

oksikoko:

--- Quote from: Cojo on February 20, 2013, 07:31:02 PM ---So my questions are:

- if I switched, have I now abandoned my current combo for good or could I just switch back if I cant tolerate Stribild?
-  might Stribild boost the CD4's?
- how is the side effect profile?
- what would you do?

--- End quote ---

Hey, cojo. I take Stribild as well. I can't offer much advice on the switch either, but since I've given it a lot of thought, here's something to add to your decision-making process:

Removing the brand names, assuming you're on "regular" doses, you're now taking:
tenofovir - 300mg
emtricitabine - 200mg
raltegravir - (400mg? I've never taken this.)

If you switch to Stribild, you'll be taking four drugs (changes from your regimen in red):
tenofovir - 300mg (same)
emtricitabine - 200mg (same)
elvitegravir- 150mg (integrase inhibitor, like Isentress)
cobicistat - 150mg liver-enzyme suppressant

The cobicistat is there because it inhibits liver enzymes (cytochrome P450 3A) that metabolize elvitegravir so you get higher concentrations with lower dosing. It also increases the overall absorption of tenofovir by inhibiting intestinal transport proteins.

The unfortunate part is that those enzymes are used to metabolize other things as well. Everyone's profile is different, but I'm only now able to drink coffee (my precious) again, because since I started Stribild, one cup is like several pots. It's too "caffeinating". Fortunately, I'm unemployed, so I was able to work through the caffeine withdrawal. I would probably have fewer side effects if I ate with it (which I am absolutely supposed to, yes, I know), but it's not always feasible/possible. I generally have it with some water.

Side effects:
I've mentioned it in other threads, but I have really weird vertigo sensations nowadays. They come and go. They're tolerable and better than the alternative, but the way I've described it is: "gravity starts moving around". I have some sleep disturbances (my day is longer than 24 hours since the Stribild). Sleep is something I used to do, I remember it well. This one is getting tougher - I should be asleep now, for instance, but I'm just. not. tired. I still get a really manic rush for about two hours after I take it.

Like tenofovir, elvitegravir and cobicistat have been associated with kidney issues (you'd need to talk to your doctor - I don't feel educated on this enough to talk about it), and the package insert recommends increased renal monitoring for all patients. I sometimes have pain, mostly in the right kidney area since starting. Once was quite severe, but I have no idea what the cause was and can't blame the drug. I have my first followup since starting Stribild next week, and I'll be sure to post any relevant info to the forum. There's also a bit of an issue with gas, but I think this is the tenofovir, so it wouldn't be new to you if it affects you at all.

My old doctor never mentioned these side effects and questioned their reality when I asked, so in all fairness, maybe it's just me. Be aware that Stribild is considered very costly as ART goes. When physicians push costly drugs over cheaper alternatives, my Spidey sense tingles, but I'm a bit paranoid. ;)

As for "what would you do?", I'd stay on the current regimen if I were in your place, but 1) I'm new, 2) there may be more benefit to the cobicistat than I'm aware of and 3) your doctor may have a very good reason. If you trust your doctor, go with what they say.

TechDude:
I am on the same boat but for different reasons. I am currently taking Atripla and been UD for a while. The doctor has seen mild liver inflammation through the blood work. The alkaline phosphatase is slowly going up and it was at 199 and the ALT is at 118.

Right now it's fine, but if the numbers keep rising, I would have to switch. Should I stick with the regimen and wait and see? If I do that, what numbers would I be looking for before I had to switch?   If I did switch over now, what would be the side effects I would be experiencing?

Thanks in advance, Mano.

Ann:

--- Quote from: TechDude on February 21, 2013, 10:46:33 AM ---I am on the same boat but for different reasons. I am currently taking Atripla and been UD for a while. The doctor has seen mild liver inflammation through the blood work. The alkaline phosphatase is slowly going up and it was at 199 and the ALT is at 118.

Right now it's fine, but if the numbers keep rising, I would have to switch. Should I stick with the regimen and wait and see? If I do that, what numbers would I be looking for before I had to switch?   If I did switch over now, what would be the side effects I would be experiencing?

Thanks in advance, Mano.

--- End quote ---

The first thing you and your doctor should be doing is exhausting all other possible causes of liver inflammation and elevated liver enzymes. Have you, for example, ever been screened for both hep B and hep C? If you haven't, you should be. Every person living with hiv should be periodically screened for both.

There are also other causes of hepatitis (hepatitis is medical lingo for inflamed liver). How much alcohol do you drink? What kind, if any, of other recreational drugs do you take and how often do you take them? What's your diet like? Dietary "fatty liver" is a growing problem in industrialised nations and it can skew your liver enzymes.

In short, don't blame the meds until you've ruled out other possible causes. 

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