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Author Topic: Shall we switch to Stribild?  (Read 5932 times)

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Offline Cojo

  • Member
  • Posts: 189
Shall we switch to Stribild?
« on: February 20, 2013, 07:31:02 PM »
I saw my doctor today and he asked me out of the blue if we'd talked about switching to Stribild yet. I must admit, it took me back.

I have been taking Truvada and Isentress now for just over a year and have maintained an undetectable viral load after a quick drop in VL of 62,000 to UD in four weeks. I have had zero side effects and have no adherence issues. Sure, 1 pill, once a day seems more attractive than 3 pills over two dosage times.

I am feeling like " if it ain't broke, don't fix it", yet, I know I get anxious about the unknown and I'd hate to pass up what may be a better option.

My CD4 count has not recovered as much as would have liked and has stayed in the 330-350 range with a few outliers.

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?
May 2011 - Tested Positive
June 2011 - CD4 330   16%   VL182,000 no resistance
Oct 6, 2011 - CD4 300  20%  VL 60,000
Oct 7, 2011 - start Truvada / Isentress
Nov 29, 2011 CD4 280 26% VL 54
Feb 7 2012 CD4 260 25% UD!
Mar 20 2012 CD4 400 28%
June 2012 CD4 330 26% UD
Sept 2012 CD4 450 32% UD
Dec 2012 CD4 310 28% UD
May 2013 CD4 500 32% UD
Oct 2013 CD4 460 33% UD
May 2014 CD4 360 33% UD

Offline buginme2

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  • Posts: 2,834
Re: Shall we switch to Stribild?
« Reply #1 on: February 20, 2013, 07:39:59 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?

1. if.you switch you can always switch back if you choose assuming your resistance profile doesn't change.

2  people are reporting few side effects.  your doctor will monitor your kidneys closely.

3. can't say. to each their own


Offline texaninnyc87

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  • Posts: 245
Re: Shall we switch to Stribild?
« Reply #2 on: February 20, 2013, 07:48:16 PM »
Maybe i can give a little feedback?

I was diagnosed in September. In december my VL was 129,00 cd4 280 (20%). I started stribild in mid january. I experienced very mild side effects. Light nausea the first few days and a little buzzed feeling, completely manageable. I take it when i wake up in between 9 and 12 with a light breakfast. after three weeks my vl went down to 80 and my cd4 to 350 (26%). based on my results i would definitely recommend the switch to stribild. my doctor is monitoring my kidney functions but so far i havent had any issues. if you have any specific questions feel free to ask me!
Dxd: 9/11/12
Blot confirmed: 11/12
12/12 cd4: 280 (20%) vl: 129,000
1/13 $tribild
2/13 cd4: 350 (26%) vl: 80
4/13 cd4: 510 (29%) vl:: 35
6/13cd4 350 (31%) vl: 21
9/13 cd4 492 (30%) vl: ud
12/13 cd4 846 (36%) vl: 100
1/14 cd4 480 (31%) vl: UD
3/14 cd4 650 (33%) vl: UD
6/14 cd4 410 (35%) vl: UD

Offline mecch

  • Member
  • Posts: 11,225
  • red pill? or blue pill?
Re: Shall we switch to Stribild?
« Reply #3 on: February 20, 2013, 08:05:53 PM »
Maybe i can give a little feedback?

I was diagnosed in September. In december my VL was 129,00 cd4 280 (20%). I started stribild in mid january. I experienced very mild side effects. Light nausea the first few days and a little buzzed feeling, completely manageable. I take it when i wake up in between 9 and 12 with a light breakfast. after three weeks my vl went down to 80 and my cd4 to 350 (26%). based on my results i would definitely recommend the switch to stribild. my doctor is monitoring my kidney functions but so far i havent had any issues. if you have any specific questions feel free to ask me!

Your experience has little in common with the OP.  You didn't switch from another combo.  This is your first and only.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline texaninnyc87

  • Member
  • Posts: 245
Re: Shall we switch to Stribild?
« Reply #4 on: February 20, 2013, 08:08:14 PM »
Duh. This is why i explained my circumstances. I was under the impression that the purpose of these forums was to share your experiences with others and hopefully help them.

Cojo, if you have any questions about my experience with Stribild please feel free to ask.
« Last Edit: February 20, 2013, 08:16:18 PM by texaninnyc87 »
Dxd: 9/11/12
Blot confirmed: 11/12
12/12 cd4: 280 (20%) vl: 129,000
1/13 $tribild
2/13 cd4: 350 (26%) vl: 80
4/13 cd4: 510 (29%) vl:: 35
6/13cd4 350 (31%) vl: 21
9/13 cd4 492 (30%) vl: ud
12/13 cd4 846 (36%) vl: 100
1/14 cd4 480 (31%) vl: UD
3/14 cd4 650 (33%) vl: UD
6/14 cd4 410 (35%) vl: UD

Offline Miss Philicia

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  • Posts: 23,883
  • celebrity poster, faker & poser
Re: Shall we switch to Stribild?
« Reply #5 on: February 20, 2013, 08:15:40 PM »
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."
"I’ve slept with enough men to know that I’m not gay"

Offline mecch

  • Member
  • Posts: 11,225
  • red pill? or blue pill?
Re: Shall we switch to Stribild?
« Reply #6 on: February 21, 2013, 12:14:17 AM »
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?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline oksikoko

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  • Writing the congressman again
    • the treatment cascade
Re: Shall we switch to Stribild?
« Reply #7 on: February 21, 2013, 02:18:58 AM »
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?

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.
Code: [Select]
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

Offline TechDude

  • member
  • Posts: 2
Re: Shall we switch to Stribild?
« Reply #8 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.

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Shall we switch to Stribild?
« Reply #9 on: February 22, 2013, 08:15:56 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.

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. 
Condoms are a girl's best friend

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"...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 Larsen

  • Member
  • Posts: 41
Re: Shall we switch to Stribild?
« Reply #10 on: March 05, 2013, 03:05:01 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.

I think Ann's comment is bang on the money. Even if you don't have hep. have you had it in the past? I've never been aware of having had heb B, but when I was diagnosed they spotted that I have natural immunity, so I have presumably had it at some point in the distant past and that has left me with a slightly elevated ALT.

On the specific question posted by the OP, I am always dubious about the rush to switch to the latest and greatest drug, with fewer side-effects. Over time the side-effects invariably come crawling out of the woodwork and they are rarely as great as the hype and early adopters swear they are.
In a far better p[lace than this minging shithole

Offline Cojo

  • Member
  • Posts: 189
Re: Shall we switch to Stribild?
« Reply #11 on: March 05, 2013, 08:15:05 PM »
Thanks for the replies folks and the science and experiences shared. I think I need to do some more research around the CD4 boosting prospects with a med switch.
May 2011 - Tested Positive
June 2011 - CD4 330   16%   VL182,000 no resistance
Oct 6, 2011 - CD4 300  20%  VL 60,000
Oct 7, 2011 - start Truvada / Isentress
Nov 29, 2011 CD4 280 26% VL 54
Feb 7 2012 CD4 260 25% UD!
Mar 20 2012 CD4 400 28%
June 2012 CD4 330 26% UD
Sept 2012 CD4 450 32% UD
Dec 2012 CD4 310 28% UD
May 2013 CD4 500 32% UD
Oct 2013 CD4 460 33% UD
May 2014 CD4 360 33% UD

Offline 14brasil

  • Member
  • Posts: 13
Re: Shall we switch to Stribild?
« Reply #12 on: March 05, 2013, 10:58:28 PM »
Cojo, the fact that you are able to start with Truvada Isentress, and do well is great. I started on Sustiva, Truvada, and yickes! the Sustiva is an ass kicker.

I did move to TnI and did well with my CD4 in the high 400s and Viral Load UD.
but I took all my Isentress at night which is not recommended but it worked for me. When I took the 1 Isentress in the morning and the other at night my days where tough because it made me so tired.

If you change to Stribild you should fill the same as you do now, most likely better. And like said before if you dont you can always go back. 

Offline Todd1234

  • Member
  • Posts: 3
Re: Shall we switch to Stribild?
« Reply #13 on: March 11, 2013, 12:13:05 AM »
I think a lot of doctors are recomending switching to Striblid because it is working so well for so many people.

Despite the saying if it isnt broke dont fix it, I think it is also time to take advantage of the next generation of new drugs.  The horse and buggie still works, but a car is much better.

For me personally switching to the quad is the best thing I have ever done..

I was back and forth between atripla and complera, now on the quad I feel so much better than I did on either one of those.

Offline aaware72

  • Member
  • Posts: 224
Re: Shall we switch to Stribild?
« Reply #14 on: March 11, 2013, 11:51:10 AM »
 This thread raises questions for me. 

What correlation is there between medication and CD4 counts?  My understanding is the medications attack the virus directly, at several different points, thus not allowing the virus to infect CD4 cells.  It is also my understanding that there are many things unrelated to HIV that effect your CD4 IE normal colds, poor health habits, stress, etc.  I do not understand how changing med would help your CD4 count if the current medications are keeping the HIV under control?

I only been on medication since 02/13

I started with Complera and had some minimal sides. (Head felt foggy, sleeplessness, diarrhea, and anxiety for a 4-5days) I end up having a resistance to Rilpivirine so we switched to Stirbild.  Been using Stirbild since 03/01 and had similar side, other than diarrhea lasted up until a few days ago, whereas it had disappeared in a couple day after the start of Complera.

This is all new to me and all I can do is share what’s going on with me, as another poster was trying to do in this thread. My experiences are not the same as the original poster, however I  can relay to the OP what short term side effect that I have seen with a drug they are considering using as well as the "lurkers" out there that are reading and don't post. 

I have another appointment tomorrow for more blood work.  I seem to be responding to these medications. However I have no idea what long term effects are going to be.  This is a new area where I'm trying to learn and gain more knowledge in, as there appears to be a lot of misinformation or outdated information out there. 

Too the OP if your current medication are working well and you feel good and your not experiencing side why change?  What are your pros and cons. 

Anyway just my 2cent for what it’s worth  :)




« Last Edit: March 11, 2013, 11:54:00 AM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Oneday/undia

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  • Posts: 17
  • What's the rush
Re: Shall we switch to Stribild?
« Reply #15 on: March 17, 2013, 01:38:17 PM »
I switch from truvada/reyataz/norvir to stribild after 3 years with my treatment and so far i have the highest cd numbers ever and no side effects . ;D
Positive nov/08. Vl 15,000 cd 400
12/08 start treatment ( norvir, truvada,reyataz)
07/12 und/cd 575/42%
12/12 start Stribild
01/13 one month on stribild cd 715/35 %
2/13 725/47% UND
08/13 709/45% UND

Offline mike88

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  • Posts: 16
Re: Shall we switch to Stribild?
« Reply #16 on: March 26, 2013, 02:19:02 PM »
Hello, new to this forum and thought I would share my experience with using Stribild. I have been taking, Norvir, Epsicom, and Reyataz for the past five years. I was an avid hiker up until two years ago when I started having difficulty with my legs. I went from being able to get a good hike in almost every day of up to six or seven miles to now barely being able to get one mile in a couple times a week and that puts me down for the next couple of days.  It seems the leg muscles along with the joint pain are getting worse with time. My doctor felt that the meds were contributing to the loss in strength so he put me on Stribild eight weeks ago. Unfortunately the Stribild only seemed to make the problems worse as well as cause some intense pain in my hands and arms. I have read some of other posts were people have said that they have had no problems with this medication but that was not the case with me. I have stopped taking it and am back on my old regiment and the symptoms seems to be diminishing. I can say that my experience with it was not worth the change.
On a second note any suggestions as to what may be causing the muscle weakness ?
and is there anyone who can relate and offer suggestions? I have seen the orthopedic and his tests show everything looks good so with no hard physical evidence we seem to be at an impasse.
 

Offline Tempeboy

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  • Posts: 356
  • Like St Francis of Assisi I am wedded to Poverty
Re: Shall we switch to Stribild?
« Reply #17 on: April 01, 2013, 03:55:07 PM »
I saw my doctor today and he asked me out of the blue if we'd talked about switching to Stribild yet. I must admit, it took me back.

I have been taking Truvada and Isentress now for just over a year and have maintained an undetectable viral load after a quick drop in VL of 62,000 to UD in four weeks. I have had zero side effects and have no adherence issues. Sure, 1 pill, once a day seems more attractive than 3 pills over two dosage times.

I am feeling like " if it ain't broke, don't fix it", yet, I know I get anxious about the unknown and I'd hate to pass up what may be a better option.

My CD4 count has not recovered as much as would have liked and has stayed in the 330-350 range with a few outliers.

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?

Hey Cojo,

Your CD4 count is increasing, and recent research shows that combinations that include Raltegravir continue to increase for 5+ years (the length of data available, and superior to Efavirenz - the industry benchmark).  Your CD4 count was a little low when you started, so you might expect your count to take a little longer to increase, and again Raltegravir based combinations have been shown to achieve superior CD4 cell recoveries.

Stribald contains cobicistat, a 'boosting' agent that as well as contributing to kidney function side effects, will boost the levels of everything that Ritonavir also boosts (Viagra and other drugs used to treat erectile dysfunction, as well as all amphetamines and other substances that use the same 'pathway' in the liver to 'break down' - possibly causing other side effects).

Raltegravir is proven and continues to show benefits over other combinations, however stribald is in it's early days.  There is a great deal of hype about 'one pill once a day' coformulations, which are compounded for profit - not necessarily for their superior anti HIV properties, and definitely not for their superior side effect profiles.
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline Reishi

  • Member
  • Posts: 20
Re: Shall we switch to Stribild?
« Reply #18 on: May 20, 2013, 06:24:46 PM »
I agree with the OP's mentality:  If it ain't broke, why fix it?  Your current regimen seems to be working fine for you.

Great advice & breakdown from Oksikoko.  I've also been taking Stribild for the past two weeks.  I'm in the same boat as Texaninnyc, in the sense this is the first & only ARV meds I've ever taken.  So, while I can't comment on switching meds, I hope someone might be able to get something useful out of this post anyway.

I've experienced similar side effects to what Oksikoko described.  Mild dizziness in the morning which wears off in a few hours, some vertigo, slight nausea, fatigue, a slight buzzing feeling, insomnia in the beginning, occasional heart palpitations, loose stools and diarrhea.  I am / was reluctant to blame all these side effects on the meds because all those symptoms can have other causes too.  Anxiety can cause insomnia, among other things.  Plus I had gastrointestinal problems even when I was HIV neg.  My digestive system overreacts to every new thing, but it seems to be adapting to the Stribild.

I have no trouble sleeping, thankfully, and the side effects seem to be gradually wearing off as my body is adjusting.  The tip about being hyper caffeinated is good to know because I consume a ton of green tea & dark chocolate, both of which contain caffeine.  I am a little perturbed about the cobicistat, knowing there's something interfering with my digestion.  But I guess it's necessary, so what can you do.

Oh, one more thing:  because Stribild is the most expensive HIV medication currently on the market, there's a chance you may have to fight with your insurance to get them to pay for it.  I ran into a little snag getting my first batch paid for and I wouldn't be surprised if I end up having to fight with them later on down the line.

 


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