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

Changing med already!

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aaware72:
Hello everyone,

I only been on meds for 16 day.  A little back ground

01/18/13-Rapid tested positive
01/25/13-Confirmed positive via blood test
02/07/13-First blood drawn
02/11/13-CD4-230, VL-50,000, 12%
02/13/13-Started Complera

So I went and seen the doctor yesterday and they took more blood

02/27/13-CD4-466, VL-Pending, 19%

Recieved some other results and found out that the strain of HIV that I have is resistant to Non-Nucleosides class of drugs. Did I state that right? My doctor switched me over to Stribild.(Just pick up today but not started)

This raises some questions, which I will also ask the Dr.,

If my CD4 count is rising and If my VL is down doesn't this mean I'm responding to the Complera?  Not sure if I understand the resistance part?  If I'm resistant to 1 of the 3 med in the Compera pill why sub a 3rd drug if the other 2 drugs are working well?  meaning if I have resistance to rilpivirine, but not the emtricitabine, and tenofovir then why just not stop the Complera and just take emtricitabine, and tenofovir by themselves?  Is there a reason to add another 3rd drug? 

Anyone have some thoughts or have some knowledge on the subject?

buginme2:
Med guidelines recommend three drugs from two different classes in order to achieve and maintain a suppressed viral load.

If you only took two meds, and from one class, you would have a significant chance of developing resistance to one or both of those meds.

Prior to about 1996 when PI's were introduced and triple therapy became common, patients were treated with one or two meds at a time.  They would do well for awhile, but then the virus would mutate and the meds would sop working.

Ann:

--- Quote from: aaware72 on March 01, 2013, 12:21:59 AM ---
Recieved some other results and found out that the strain of HIV that I have is resistant to Non-Nucleosides class of drugs. Did I state that right?


--- End quote ---

Yes. The Non-Nucleoside class of drugs is also called the NNRTI class and it includes Sustiva, Viramune and the backbone-drug of Complera, rilpivirine, amongst others. Resistance to the NNRTI class is one of the most common.


--- Quote from: aaware72 on March 01, 2013, 12:21:59 AM ---
If my CD4 count is rising and If my VL is down doesn't this mean I'm responding to the Complera?


--- End quote ---

You will have both a "wild-type" (regular hiv that has no resistance) and resistant hiv. The wild-type usually outnumbers the resistant strain, so the improvements you're seeing are the result of the wild-type virus being brought under control.

Once the wild-type is under control, the resistant strain will keep replicating and the end result is that you will probably never achieve an undetectable viral load while taking a combo that you're partially resistant to.

If you continue taking a sub-optimal combo, you run the chance of becoming resistant to the other two meds in the combo, both of which are from the NRTI class.


--- Quote from: aaware72 on March 01, 2013, 12:21:59 AM ---
If I'm resistant to 1 of the 3 med in the Compera pill why sub a 3rd drug if the other 2 drugs are working well?  meaning if I have resistance to rilpivirine, but not the emtricitabine, and tenofovir then why just not stop the Complera and just take emtricitabine, and tenofovir by themselves?  Is there a reason to add another 3rd drug?


--- End quote ---

As Bug pointed out, you need to be on at least three drugs from two classes in order to stop resistance happening.

The combo med that you're being switched to is actually four drugs. Two are ones that you're already taking. The third is a drug called elvitegravir and it's from the integrase inhibitor class of drugs.

The fourth drug in your new combo is called cobicistat. It is a pharmacokinetic enhancer, which basically means it boosts the levels of elvitegravir in your blood.

Many other combos include a fourth "booster" drug. Many combos that have a PI (Protease Inhibitor) as their backbone include a booster, usually low-dose Norvir.

You can read about the different meds here.

You can read about the life-cycle of hiv and why different meds from different classes are necessary to control hiv here.

You may also want to look at all the other Lessons that are available on this website - click here.

aaware72:
Thank you buginme2 and Ann.  Your responses cleared up at lot for me.  :D

I had choice today to take the pink pill or the blue pill.  Your responses made it easier to take the blue pill today. 

texaninnyc87:
Is your stribild blue? Mine's green.

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