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Author Topic: VL low, but stays - changing meds?  (Read 1307 times)

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Offline sevillano

  • Member
  • Posts: 42
VL low, but stays - changing meds?
« on: December 23, 2013, 09:20:31 AM »
Hey guys,
long time no hear = no problems :D

So,
just a short report: jan 2011 got infected, feb 2011 got diagnosed, dec 2011 went on drugs (norvir, reyataz, truvada) - no problems! have been on the same combo since decembre 2011, CD4 went up from 300 to 500 quite fast, VL went down from millions to UD in a couple of weeks...

but... there is always something haha... in april 2013 (so after being UD more than a year) VL came back - like 60 copies/ml, after 3 months it went down to 45 copies/ml (so I was not UD anymore), after 6 months I was UD again, but now its here again - 90 copies/ml, CD4 566, 35%... I was suggested to change my regimen from Reyataz-Truvada-Norvir to NNRTs ... kinda dont wanna go on stocrin and im trying to avoid isentress (food issues), so ... nothing more left on that side...

What would you do? Would you wait a bit more (I mean I already waited more than my doc wanted, coz he suggested to change immediately after the second sample came back)? I would go on Prezista but will this make any difference - I mean reyataz and prezista are from the same group?

I just got my docīs email saying I should come back and talk with him about changing my combo and I just texted him saying that I am not really sure I wanna do it and that I will make up my mind in next days.... My doc is very nice and he takes care of me and he answers all my questions, but I still wanna hear your opinion :D thanks guys
« Last Edit: December 23, 2013, 09:22:51 AM by sevillano »
----------------------------------------
dec 2010       - tested neg
22.01.2011    - infection
10.02.2011    - tested poz (test of 4th generation)
18.02.2011    - ELISA test poz
                    - VL: 5 mio
                    - CD4: 421 (19 %)
                    - CD3: 1709 (78%)
                    - CD8: 1267 (58%)
may 2011 - CD4: 428 (21%)
                  VL: 250 000
august 2011 - CD4: 398 (24%)
                      VL: 50 000
november 2011 - CD4: 320 (24%)
                           VL: 134 000
09.12.2011 - CD4: 284 (26%)
16.12.2011 - started TRUVADA/REYATAZ/NORVIR
16.3.2012 - CD4: 373 (25%), VL: 459

Offline Jeff G

  • Administrator
  • Member
  • Posts: 13,170
  • How am I doing Beren ?
Re: VL low, but stays - changing meds?
« Reply #1 on: December 23, 2013, 12:08:05 PM »
I would listen to what my doctor had to say and most likely defer to his or her judgement .

There are lots of combos out there now so why take a risk of becoming resistant .
Did your doctor do any resistance testing ? . I would have that done before I made any combo changes if I were in your situation, and I was once and had the test done  .

Offline sevillano

  • Member
  • Posts: 42
Re: VL low, but stays - changing meds?
« Reply #2 on: December 23, 2013, 12:27:54 PM »
Yeah, we talked about test of resistance, but his opinion was that if there was any resistance issue, my VL would have changed into thousands if not ten thousands of copies ... thats why we havent done it yet...
----------------------------------------
dec 2010       - tested neg
22.01.2011    - infection
10.02.2011    - tested poz (test of 4th generation)
18.02.2011    - ELISA test poz
                    - VL: 5 mio
                    - CD4: 421 (19 %)
                    - CD3: 1709 (78%)
                    - CD8: 1267 (58%)
may 2011 - CD4: 428 (21%)
                  VL: 250 000
august 2011 - CD4: 398 (24%)
                      VL: 50 000
november 2011 - CD4: 320 (24%)
                           VL: 134 000
09.12.2011 - CD4: 284 (26%)
16.12.2011 - started TRUVADA/REYATAZ/NORVIR
16.3.2012 - CD4: 373 (25%), VL: 459

Offline vertigo

  • Member
  • Posts: 142
Re: VL low, but stays - changing meds?
« Reply #3 on: December 23, 2013, 12:49:02 PM »
Not sure what you mean by "food issues" in regards to Isentress?  There is no meal requirement for that drug … you can take it either with or without food.  It's very effective and quite easy to take, the only catch is that it is twice daily.  Are you referring to Complera, instead?  (same class as Efavirenz/Stocrin, but requires 400 calorie meal)

Or from the same integrase inhibitor class as Isentress you could try Stribild (1 pill/day) or Tivicay/Truvada (2 pills/day).  In any event, if you are having persistent low-level viremia, you should definitely follow your doctor's advice on changing meds.

Offline eric48

  • Member
  • Posts: 1,204
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: VL low, but stays - changing meds?
« Reply #4 on: December 23, 2013, 05:23:33 PM »
Hi sevillano,

Nice to see you back.

As you know no doctors on this forum

You started treatment 'in the millions' and at year 2 you have 2 mini blips...So what?

....Blip......blip.....bubbles......

Champagne and Chocolate recommanded

Merry Xmas

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 sevillano

  • Member
  • Posts: 42
Re: VL low, but stays - changing meds?
« Reply #5 on: December 23, 2013, 06:02:09 PM »
Hey guys,

Isentress: I read that Isentress needs to be taken with food as well and besides that its 2x/day

Eric: Yeah, thats what I think, but my doc says that my VL can not be seen just as a blip, coz it was there in 3 samples in a row, then UD and now its here again, so... he wants me to change my combo :( now he suggested to go on Prezista but as a 2x/day regimen - coz i am not a naive patient anymore he wants me to follow 2x/day dosing... anyway, we gonna wait for another 3 month period to see what happens...

more opinions? :DDDthanks
----------------------------------------
dec 2010       - tested neg
22.01.2011    - infection
10.02.2011    - tested poz (test of 4th generation)
18.02.2011    - ELISA test poz
                    - VL: 5 mio
                    - CD4: 421 (19 %)
                    - CD3: 1709 (78%)
                    - CD8: 1267 (58%)
may 2011 - CD4: 428 (21%)
                  VL: 250 000
august 2011 - CD4: 398 (24%)
                      VL: 50 000
november 2011 - CD4: 320 (24%)
                           VL: 134 000
09.12.2011 - CD4: 284 (26%)
16.12.2011 - started TRUVADA/REYATAZ/NORVIR
16.3.2012 - CD4: 373 (25%), VL: 459

Offline vertigo

  • Member
  • Posts: 142
Re: VL low, but stays - changing meds?
« Reply #6 on: December 24, 2013, 02:35:42 AM »
A similar question was recently answered by Dr Young on TheBody:

http://www.thebody.com/Forums/AIDS/Meds/Q233109.html

Read the linked journal article for the latest thinking on this topic.  Bottom line is that VL <50 thought to be OK, but not persistent >50

Offline sevillano

  • Member
  • Posts: 42
Re: VL low, but stays - changing meds?
« Reply #7 on: December 24, 2013, 05:04:04 AM »
Hey,
thanks for the link! - very useful, it seems that my doc follows the same guidelines..
----------------------------------------
dec 2010       - tested neg
22.01.2011    - infection
10.02.2011    - tested poz (test of 4th generation)
18.02.2011    - ELISA test poz
                    - VL: 5 mio
                    - CD4: 421 (19 %)
                    - CD3: 1709 (78%)
                    - CD8: 1267 (58%)
may 2011 - CD4: 428 (21%)
                  VL: 250 000
august 2011 - CD4: 398 (24%)
                      VL: 50 000
november 2011 - CD4: 320 (24%)
                           VL: 134 000
09.12.2011 - CD4: 284 (26%)
16.12.2011 - started TRUVADA/REYATAZ/NORVIR
16.3.2012 - CD4: 373 (25%), VL: 459

Offline newt

  • Member
  • Posts: 3,887
  • the one and original newt
Re: VL low, but stays - changing meds?
« Reply #8 on: December 24, 2013, 07:23:56 AM »
Prezista will probably make a difference, having a much greater inhibitory power than Reyataz. Personally, if I was making this switch, I'd start on 1 x day dose and see, if viral load still stays above 50, I'd look at 2 x day dose

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

Offline eric48

  • Member
  • Posts: 1,204
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: VL low, but stays - changing meds?
« Reply #9 on: December 24, 2013, 12:50:53 PM »
This is a very interesting link indeed... (Thanks vertigo)

It reminds us the risk associated with a (blind) class change...

The reference provided by Dr Young is a very comprehensive review and will help many of our members. Therefore I post it here below:

viral load white paper by B. Taiwo

http://www.aahivm.org/Upload_Module/upload/Provider%20Resources/viral%20load%20white%20paper%20final.pdf

I made a TinyUrl just in case:

http://tinyurl.com/qzlblor

Using the educational graph in this publication and the proposed cut off value of VL = 50 may help differentiate between blips and PLV

Since treatment was started at very high VL, this is a risk factor for both (blips and/or PLV/LLV)

Since we do not know the time scale for the VL measurement point, I 'd recomand sevillano to try to graph, possibly on the same graph as the one in the PDF

Besides, the switch to Prezista as proposed by doc seems convienient, reasonnable and is not a class change. Maybe your initial post was a bit confusing about the options that your doc is putting on the table

Get yourself mentally ready for next VL and doc visit

The review by Dr Taiwo will be usefull to many .

Merry Xmas  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 klassykitty

  • Member
  • Posts: 381
Re: VL low, but stays - changing meds?
« Reply #10 on: December 29, 2013, 06:36:43 PM »
sevillano

  One of the reasons my doctor has me on truvada/isentress is because you don't have to take them with food.  I have such weird hours and  may take my pills at 6am and 6 pm one day and 9am and 7pm the next.  It's usually the morning pill that i don't eat anything when I take it;  the evening one I take at bed time and just have crackers or something light like that.

Good luck at your next doctor appointment.

Michelle 8)
How to handle stress like a dog:
If you can't eat it or play with it.....
then pee on it and walk away

Diagnosed 01-20-2011
01-23  CD4 32    VL 125,400
02-18        76     VL 189
03-14  no cd4 test done   VL-52
04-14   69  VL-UNDECTABLE  YEA!!
05-26   50  whoopsy  
06-27   71        %-7
08-15   64 WTF %-9 
10-16  80         %7  
2012  CD4  %Thing   VL-UD
01-18  87    7
04-18  93    8  
07-16  151  8         
10-18  83    9    VL-70
2013   CD4   %thing       VL-UD
01-28  121     9
04-24  148    11   
07-25  157    11   
10-22  185    13
2014   CD-4  %thing   VL-UD
02-07 201 YEA!!!!!!  12
06-03  205      12

 


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