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Author Topic: Jesus....Kaletra Truvada & Now Sustiva?  (Read 2319 times)

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Offline FiercenBed

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  • Posts: 183
Jesus....Kaletra Truvada & Now Sustiva?
« on: December 20, 2006, 02:40:05 PM »
god i wish this virus would just settle down and give me a break....been on kaletra & truvada since june. the lowest my vl count ever got was in the 700's and cd4's up in the 300. did a vl test 2 months ago and it shot up 2 shy of 4,000. well red flags and bells from the doc and he double the kaletra from 4 a day to 6 and did a genosure test and said be prepared to change meds. so i went on vacation <amsterdam ...itza blast> before starting new meds and to get my self prepared for all the side effects all over again. so the dam genosure test comes back sensitive or 'clean' to everything w/ no resistance except 1 mutation 63p. doc said thatz no big deal. so everybody starts accusing me of not taking the meds. doc sez thatz the only medical explanation other then that he has no idea why i wont 'suppress'. he claims to have talked to people @ NIH since this is so unusual. NIH sez the same thing.....hez not taking his meds. I HAVE NEVER MISSED A DOSE!....NEVER. even on vacation i got up in the middle of the night to take them on time. so i guess to squeeze the insurance company out of 1 more dime before the end of the year he does another vl and cd4 this time. vl 2550 and cd4 428.

so at the end of the day he wants ADD sustiva to the mix. it sounds like to me hez just throwing medication @ the problem instead of finding out what the problem is. w/ all the stuff iv read on here about the 'orange bomb' last thing i wanna do is start sustiva on top of the mix. he said the only other option was azt.

anyone else have no resistance and cant get <50. any1 taking kaletra and sustiva together? should i find another doc for 2nd opinion? it just seems to be a big mess. any suggestions would help. thanx  ???

oh yea ho ho ho merry christmas.

Offline newt

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Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #1 on: December 20, 2006, 05:00:45 PM »
Do go for a second opinion

Before I go on, I will say most docs in this  situation would add in an NNRTI like Sustiva.  The Kaletra etc has done a big trick, just not enough. Some people need the extra drug.  This is called empirical treatment, ie can't be bothered to do more workup.  It will most like work fine and deliver the desired result.  Need to keep a special eye on your blood lipids though.

Kaletra etc, well, some people just don't absorb the drug and this can be measured, and sometimes the dose even adjusted upwards to compensate.  The test used is caused therapeutic drug monitoring and determines the levels of a drug, Kaletra in this case, in your body to see if its at an effective concentration, and importantly when (kinda settles whether your taken the damn things or not too :-) ). Unfortunately, it's non-standard in the US (but freely available in the UK and most of Europe). 

If you are on Kaletra 1 x day, switching to 2 x day may improve/resolve things.  It was originally designed as a 2 x day drug.  The pharmacokinetics (how the drug moves round your body) is better/safer. 1 x day kaletra is fine for many people but can lead to a low end-of-dose drug level which means virus don;t get completely suppressed.

- matt
« Last Edit: December 20, 2006, 05:17:47 PM by newt »
"The object is to be a well patient, not a good patient"

Offline thunter34

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  • His name is Carl.
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #2 on: December 20, 2006, 05:16:31 PM »
For the record:  It really grills my cheese a bit, too....how sometimes docs seem to get the attitiude that they know the virus and how your body works better than either you or the bug itself.

I feel ya on that one...
AIDS isn't for sissies.

Offline FiercenBed

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  • Posts: 183
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #3 on: December 20, 2006, 06:31:14 PM »
doc got me up to 6 kaletra a day......can ya go any higher? what about liquid kaletra? do u think that might help?  someone else suggested an 'absorption test' and i mentioned it to the doc and he said he never heard of something like that. kinda scary huh?

Offline thunter34

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  • His name is Carl.
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #4 on: December 20, 2006, 06:35:34 PM »
For the record (in response to newt's 1x vs 2x a day dosing statements):  I opted for twice a day Kaletra dosing for that very reason (I was given the choice for either once or twice).  It requires a bit more diligence on my part, yes...but I think the pay off is worth it for more consistent blood levels.

blah, blah, blah. (that last part added for no paticular reason)
AIDS isn't for sissies.

Offline newt

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  • the one and original newt
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #5 on: December 20, 2006, 06:51:57 PM »
Absoption test = therapeutic drug monitoring, basically they take some blood samples, note the time you took your meds and plot your drug level against the therapeutic range.  It's a standard blood draw, maybe at an odd time (ideally including close to end of a dose to get the lowest level).  Blood is sent in a red-stopper tube or lavender-stopper (EDTA plasma) tube or green-stopper (heparinized plasma) tube (frozen or in a cool bag) for analysis. LabCorp do this kind of test, its called HIV TheraSure -- order ref is 716828 for Kaletra (this is not a recommendation, other companies do this test too, just if your doc uses a lab that stocks LabCorp tests it may be helpful info).

There's only so much Kaletra you can take. Maybe better to add another drug, obvious candidate is Sustiva as you seem to have no NNRTI resistance, but another PI like Reyataz or even perhaps a nuke like Ziagen may do.
 
- matt
"The object is to be a well patient, not a good patient"

Offline FiercenBed

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  • Posts: 183
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #6 on: December 20, 2006, 08:47:43 PM »
newt 
ur like mr doctor....lol.....r u a doc? u always have a specific answer to just about any question. for some reason my doc keeps shouting at me......."STAY OFF THE INTERNET".

like i said..... the things things iv read about sustiva make it sound like satins' posion. im just back up on my feet again after the kaletra and feeling pretty well. the last thing i wanna do f*uck it all up again.

dosnt it seem odd iv asked my doc about an absortion test weeks ago and he dosnt know anything about it!?

im gonna get the doc by the balls and get this test done.......thanx

once again....anybody have any thought on liquid kaletra?
« Last Edit: December 20, 2006, 09:30:34 PM by FiercenBed »

Offline dgls44

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!
« Reply #7 on: December 20, 2006, 10:52:19 PM »
~
« Last Edit: December 24, 2006, 12:32:06 AM by dgls44 »

Offline FiercenBed

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  • Posts: 183
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #8 on: December 21, 2006, 12:15:09 AM »
this is 6 pills of the new kaletra a day.......3 in am and 3 in pm.

from what i hear there is a liquid version that they use for children. common sense would say a liquid version of a drug would absorb better then pills. common sense?

Offline dgls44

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!
« Reply #9 on: December 21, 2006, 02:58:03 AM »
~
« Last Edit: December 24, 2006, 12:32:37 AM by dgls44 »

Offline newt

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  • the one and original newt
Re: Jesus....Kaletra Truvada & Now Sustiva?
« Reply #10 on: December 21, 2006, 03:55:07 AM »
I'm am not a doctor, I got smart about treatment when my ex (then not my ex) went anaemic on AZT and was badly affected by Sustiva, and discovered I am good at being nerdy about combo. It comes in handy. :)

I'm gonna summarize, just to get my head clear

1. You had a 6 figure viral load and now its gone down to 4 on a standard combo, but not yet undetectable
2. A genotype says you have no resistance
3. Your doc has tried upping the Kaletra by a third more, but it ain't worked
4. Your doc thinks you ain't taking your meds but you are, religiously
5. You ain't keen on adding in Sustiva (understandable)

Two tests your doc can do are (1) an old-fashioned phenotype resistance test (not a virtual one), the kind that look at if the drugs stop the virus growing in a test tube (eg PhenoSense, many companies do this kind of test), and (2) the absoption test.

These may give useful info, like discover a resistance not suggested by the genotype (happens sometimes) or that you ain't getting enough of a particular drug.

If the phenotype shows one or more of the drugs in your combo ain't working at full strength then you can think about a different combo based on which drugs the test says are effective.

If the absoption test shows Kaletra ain't at a high enough level you can think about what to do - add more yes, but this will push the level of Norvir higher, and this is not good or kind (liver, heart and stomach wise), maybe better to go with a different med.

If the tests show nada & you wanna stay with Kaletra pretty much the only option is to add another drug for strength.  Sustiva will be many doc's drug of choice, cos it's a different class & well strong (& well marketed >:(), but it is not the only choice.  The other NNRTI Viramune (no dreams, very rarely anxiety etc), another PI or another nuke, prob AZT or Ziagen, will also be good bets.

Alternatively you could just ditch the Kaletra and go for (1) an NNRTI-based combo or (2) a different PI and see if this works.

This is the kind of situation where a second, really expert opinion can make a difference.

On the other hand, extra tests/opinions may just take up time & money.  Your genes affect how the drugs work, there's nowt anyone can do about that, the end suggestions may come out the same: try a different combo or add an extra drug (soz). BUT the choice of how to proceed now should be yours, eh?

- matt
« Last Edit: December 21, 2006, 03:57:56 AM by newt »
"The object is to be a well patient, not a good patient"

 


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