Atripla or Stribild... Need to decide.... help guys.

[survivor703]

Hi guys,

I've finally come to the point to where I've decided to start meds. My doctor gave me the choice of 3 one a day regimens, Atriple, Complera, or Stribild.

After doing my research, I've found that a component in Atripla, efavirenz, is a cause for CNS side effects, (e.g., nightmares and diziness). I've also seen that people sometimes develop a rash with the Atripla regimen.

On the other hand, I've been looking into the stribild as an alternative to Atripla. Research suggests that these CNS side effects & rash are statistically less probable to occur while taking the stribild. So I'm leaning towards taking the Stribild as my first line treatment.

I would like to avoid diziness at all costs, since I commute 70 miles for work everyday, and I have to drive. I had to take acyclovir for ten days, and I kept getting dizzy spells. One of the dizzy spells was so bad that it scared me enough to get my hubby to drive me to the ER. I was sweating and everything... no fun at all. I think it's just a common effect of antiretrovirals to cause diziness. Anyway, I digress.

My question is, if anyone else is taking the stribild, did you have any notable side effects?

The only barracade to getting the stribild is my insurance. I have Aetna (through my employer), and they want people to try Atripla for 30 days first with documented side effects before they will authorize Stribild. So I get the atripla filled to comply, but I don't want to take it.

And another random unrelated question... I wonder if my employer can see my medical records and the presecriptions I'm getting.

Thanks for all your help guys. This forum is a lifesaver.

Best,
survivor

[Bizkits]

I can't tell you from any personal experience, as I'm in the same boat as you as far as meds. I'm about to start next week and have to consider some choices, unless anything changes by then.

As far as what experience I can talk from, as a RN, I have worked a ton with patients, insurance companies and I can offer you some advise as to what we have done helping some people out:

As far as side effects go, I'm pretty sure I've read the same things you have. But, ANY medication from ART to acid reflux is going to come with the warning of side effects, some more probable than others but that's just how it is. I DO know a couple of people on Atripla that have said they've never once had side effects, I know one that takes his at night with a bowl of ice cream just because he enjoys the "vivid dreams" that much...Also, I know one who had a horrible reaction to the sustiva and had to back track big time. The thing about side effects, is you may have them, you may not. It might be worth a try...BUT do it wisely...dizziness and driving are a bad combo, but it sounds like you already know that. Is it possible to start meds on the weekend where you don't have to worry about work or taking them at night to avoid some of the most noticible ones? May want to consider that you might have side effects with stribild, too. Gotta start somewhere.

Now, *hint hint*. That being said...There are 2 kinds of side effects. Objective and subjective. The difference being did we observe these side effects or did the patient report them to us.  As far as medication goes, all we need to know is that the patient had a side effect...to get another drug approved.  I'm not telling you to do anything here...just take that as it is.

Atripla/Stribild may be a little different because some of the effects are known to exist and go away in many after a certain period of time.  When talking the expense of hiv drugs, insurance companies are probably pretty strict. (My doc tells me she usually gets what she wants)...whatever that means...

As far as I know, your employer has no right to know about your medical treatment or medications. I could be wrong, but I'm pretty sure that is none of their business and possibly even illegal. The only case I've seen where it was is when a person had a workplace accident resulting in an injury and their piss test showed positive for narcotics. He had to show that he had a valid prescription for hydrocodone not to lose his job.

(Please don't beat me up Aunty Ann...I didn't think this was a pirouette at all...lol)

[buginme2]

The only barracade to getting the stribild is my insurance. I have Aetna (through my employer), and they want people to try Atripla for 30 days first with documented side effects before they will authorize Stribild. So I get the atripla filled to comply, but I don't want to take it.



Best,
survivor

Well that's very adult of you.   Your going to have your insurance co purchase a $2000 medication so it can sit it your cabinet so you can get the one you want? 

First world problems eh.? 

[survivor703]

Hi Bizkits,

thanks for all your insight, and particulary to the "obective/subjective" side effects... This helps making the decision a lot easier. I'm going to proceed with the stribild next month provided that the insurance company agrees, lol.

Thanks

[survivor703]

Hi Charlie Brown (buginme2),

Thanks for your input as well, but who said anything about letting the medicine sit in my cabinet??? Oh ye of little faith. lol...

Check out the link sourced in the footer of this reply to get a more accurate depiction of what I'll do with the unused atripla.

Kindest Regards,
survivor


http://www.thebody.com/content/38429/aid-for-aids-international.html

[newt]

Many local ASOs take unopened unused meds to supply people with no insurance etc, charity begins at home perhaps.

Good luck with your choice.

- matt

[survivor703]

Thanks for that info Newt. That's good to know... I did a google search, and it pointed me all the way to California to the link I mentioned previously. A local ASO would be easier, of course.

[Niceguy2013]

I wonder if your doctor could recommend that you start stribild due to your history of dizzy spells. You might be able to get prior authorization to start stribild first. It's terrible that insurance companies are trying to decide your hiv treatment plan.

[aaware72]

I have been on Stirbild for over a year now with no real side effects as of right now. 

I would fight the insurance company as I am also on an Aetna policy. 

I know your doctor has given you choice, but what does he recommend? The insurance company is mandated to follow what the doctor prescribes.  If Stirbild is a covered medication on the policy then the insurance company has no say to tell you well try this first....   

[tednlou2]

I just read this from Dr. Gallant.  In his list of preferred regimens, he leaves off Atripla.  He says it has served us well, but there is no need to deal with the possible CNS side-effects, since there are other regimens to use instead.  I do not think Atripla has fallen off the official preferred list, but I've noticed more and more docs taking it off their list. 

What's the difference in price, which would prompt them to do this 30 day thing?

http://www.thebody.com/content/74191/antiretroviral-therapy-in-2014-how-does-a-doctor-c.html

[Bizkits]

Interesting article. I'm actually pretty anxious about my own appointment this upcoming Monday, this is the one where I start meds. I will also have to consider Atripla, though more and more I really don't want to. But I really would prefer a once-per-day regimen. So I can empathize with survivor.

As far as what drugs your insurance will allow, there are what we call "formulary" and "non-formulary", some may even refer to them as "preferred". Insurance companies usually strike deals with drug manufacturers as do various doctors offices, etc...sometimes it can make a huge difference in cost. (kickbacks, incentives, discounts, etc...) When talking medications overall, say if a patent has run out and several different companies can now start manufacturing a generic version of a drug as opposed to a brand name, it can become much cheaper, too. The insurance company would of course much rather prefer to supply a cheaper drug than a more expensive one. As I've talked to one of our pharmacists, stribild is apparantely more expensive than atripla. They  also told me that likely there's not enough data on stribild to say it is as effective or better than atripla. So, insurance is going to look for a reason as to why they should pay the extra cost for stribild when atripla can be just as effective. That's when your doctor can get involved (or make the nurse or pharmacist do all the leg work grrrr). When initially discussing treatment/medication/labs, etc...my doctor said she usually gets what she wants. But that's not to say it doesn't go without a little fight.

I've met some lazy doctors for sure, but I have yet to meet one that doesn't have your best interests in mind. It also seems most ID providers are pretty passionate about what they do and will fight for their patients.

[drewm]

Hey, I am on Atripla. The dreams are vivid. I would not describe them as nightmares. I have not had dizziness. Personally, I think Atripla gets a bad rap but that's ME. Good luck with whatever decision you make.

[mpositive]

Never tried Atripla.  I have tried other regiments, but, I am on Stribild right now.  Absolutely no issues for me.  I have never really heard of anyone having issues with it.  I take it at 630p everyday, and I go to bed super early, so if there is a dizzy effect, I am unaware.
FYI  -  I am on Aetna as well.

[survivor703]

Okay, so I want to thank everyone for their insight.... very good stuff!! I have considered all things, and I've decided to go with stribild. My doctor is going to do all the "red tape" stuff to get Aetna to approve it.

Now, with that being said... Do any of you stribild users recommend what time I should take the medicine? or does it matter?

Thanks again,
Survivor

[MrPOZ]

Survivor,

I would suggest morning (but everyone has their preference).  My reason is it forces me to have a nutritious breakfast.  Also, one of the components in Stribild (Cobistat, I believe) has a much longer bioavailability if you eat it with a high fat meal.  A high fat meal in the AM is better than a high fat meal later in the day for me. Those are my thoughts and Stribild will definitely bring down your viral load.  Good luck.

MrPOZ

[Reggie]

Hello Survivor

I see your starting stribild and as someone whose 5 months into taking atripla would appreciate any feedback you could give as I'm thinking of possibly switching in the future due to the sleep issue.

Thanks and hope all goes well for you.

Reggie