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Author Topic: Ritonavir and Darunavir  (Read 1808 times)

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Offline MarkB

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Ritonavir and Darunavir
« on: November 15, 2024, 10:42:42 am »
I hope I'm posting in the right forum.

For the last 13 years I have been on Eviplera (single pill), which was later changed to a combination of Tenofovir and Rilpivirine. My CD4 has consistently been around 1400, with a percentage of 45.

I had never missed a single dose in all that time. However, I was recently admitted to hospital, as a result of which I missed three successive days of my meds. On discharge, I informed my clinic of what had happened; they had concerns that I might have built up a resistance to the previous regime, so they changed me to a combination of Tenofovir, Ritonavir and Darunavir.

In the last two days I have developed an unpleasant full body raised rash, and am now trying to get advice from someone at the hospital (apparently the clinic doesn't have an out-of-hours contact). I have a suspicion that either Ritonavir or Darunavir has caused the rash.

The questions I have are these: do I (a) come off meds altogether until things become clearer; (b) continue with the Tenofovir / Ritonavir / Darunavir and hope that the body adapts; or (c) return to the former Tenofovir / Rilpivirine regime?

Your advice would be welcome -- thank you.


Offline Tonny2

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Re: Ritonavir and Darunavir
« Reply #1 on: November 15, 2024, 12:01:01 pm »



               ojo.        Hello there!… Great numbers!… First about, I don’t know why they switch you to a different treatment just because you stop taking only three days to medication but I guess, they are the experts. Well, I guess you had to wait until your body Get used to the new treatment, some people get a rash with Ritonavir. please talk to your doctor and and keep us posted… Good luck.

Offline MarkB

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Re: Ritonavir and Darunavir
« Reply #2 on: November 15, 2024, 12:07:17 pm »
Thanks for the reply, @Tonny2. I'm still waiting to hear from a doctor or a pharmacist.

Offline Jim

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Re: Ritonavir and Darunavir
« Reply #3 on: November 15, 2024, 12:58:06 pm »
Quote
I was recently admitted to hospital, as a result of which I missed three successive days of my meds. On discharge, I informed my clinic of what had happened; they had concerns that I might have built up a resistance to the previous regime, so they changed me to a combination of Tenofovir, Ritonavir and Darunavir.

I, would not have done this, no way am I switching over 3 days. 

I might have opted for having an additional viral load done in 30 days to calm them down or offered to stop for 14 days and then start with Tenofovir and Rilpivirine again, so they don't get their knickers in a twist but the reality is I would have been happy just carrying on without additional checks.

Anyhow, its happened now.

Quote
In the last two days I have developed an unpleasant full body raised rash, and am now trying to get advice from someone at the hospital (apparently the clinic doesn't have an out-of-hours contact). I have a suspicion that either Ritonavir or Darunavir has caused the rash.

Rash should not be ignored. I would drop by the ER but whatever you do don't ignore it.

Anyhow, if it is a side effect of the Darunavir (Prezista) I would switch back to the former Tenofovir / Rilpivirine regime as you said worked for you and a month later do a VL test. However, that would be my choice, you need to do what you want in consultation with your doctor.


Quote
However, I was recently admitted to hospital

I hope whatever the reason, you are now feeling better and recovering.


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Offline Jim

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Re: Ritonavir and Darunavir
« Reply #4 on: November 15, 2024, 01:06:44 pm »
Quote
I was recently admitted to hospital, as a result of which I missed three successive days of my meds. On discharge, I informed my clinic of what had happened; they had concerns that I might have built up a resistance to the previous regime, so they changed me to a combination of Tenofovir, Ritonavir and Darunavir.

Very paranoid and dated, it nearly sounds like some of the HSE staff (The public health system we have here)
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Offline MarkB

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Re: Ritonavir and Darunavir
« Reply #5 on: November 15, 2024, 01:08:36 pm »
Hi Jim and thank you for the reply. I didn't have much of a say in the matter: the clinic told me that even three days might be enough to interfere with the regime I'm on, and it was their choice to change the meds. At the moment, the rash has spread all over my body, and is rather uncomfortable. I'm still waiting for somebody to ring; but your advice is wise: if it continues, I will head off to A&E and sit there until someone examines me.

It's all a bit galling after 15 years' unbroken adherence to my medications. Just goes to show, I suppose.

Thanks again.
« Last Edit: November 15, 2024, 01:11:46 pm by MarkB »

Offline Jim

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Re: Ritonavir and Darunavir
« Reply #6 on: November 15, 2024, 01:11:07 pm »
Quote
to A&E

Aha, the NHS...

Yeah go to A&E and switch back and as for their choice, next time tell them you will not do it and same as HSE the ID clinc will give in as they don't want to ruin their stats by having you run around untreated.

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Offline Jim

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Re: Ritonavir and Darunavir
« Reply #7 on: November 15, 2024, 01:14:09 pm »
Hope you feel better soon. Hopefully, the A&E staff can rule out other causes or infections causing the rash and if so give you some antihistamines or something for the reaction.
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Offline leatherman

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Re: Ritonavir and Darunavir
« Reply #8 on: November 15, 2024, 04:42:35 pm »
so lets talk about why your clinic (maybe, probably) didn't make the right decision IMHO. (not necessarily the wrong decision; but not really the best one).

Resistance can happen when the med level falls too low to adequately block HIV.

Following data on a med's half-life, most meds are out of your system in 25-48 hrs. For a single incidence of skipping a pill, there's actually only little a short period of time in the last part of that time period in which the med level will be too low and resistance could happen. A quick caveat to point out here is that resistance at this timepoint is NOT guaranteed. The probability isn't even very high.

After that, there isn't any med level left in your body trying to block HIV and hence nothing for HIV to mutate against. Because of this timeline, rarely does missing a single dose ever cause resistance. Matter of fact, the data shows that you can be just 95% adherent monthly to HIV meds and yet still maintain a UD VL and not develop resistance.

Resistance actually most regularly occurs because a patient is only randomly taking doses of their medication. For example after missing that first dose, if a person was to take the next dose in say 24 hrs, then take meds for 2 days, then miss dosing 36 hrs later, then take a dose the regular 24 hrs later, then miss a dose. This up and down, up and down cycle leads to med levels staying too low for too long. This much longer time of meds being too low is the perfect scenario for HIV to mutate.



the clinic could have treated this situation like a temporary "med holiday" and told you to remain off meds for another 4 to 14 days ( 1 to 2 wks) and then restarted your original meds or switched meds. Of course, a VL test would be needed in  to 6 wks to make sure resistance didn't happen and/or that the new meds were working.

Or quite frankly, since we just went through a similar issue in my house. My husband took meds in the morning; had a stress test, heart attack, and quadruple bypass surgery, subsequently missing 4 1/2 days of meds before hospital got their act together (after I brought the meds in myself). We just had his bloodwork done 2 months later and his VL was UD still (after 27 yrs of meds) and he amazing had his highest CD4 count ever.

Of course your results could vary :D but I would have simply kept on my original meds. A test 6 weeks later would have easily confirmed your original regimen was still working and if not then you could have tried something else.

A rash?? That's an adverse allergic reaction to a medication more than likely. If it were me, I would immediately return to my original regimen and then deal with the doctor and revoke those new prescription changes.

Needless to say, I'm not a doctor; but after 30 years of meds, resistance decades ago, and a lot of education/advocacy work, this has all been my advice. Here's a helpful link to more information https://www.aidsmap.com/about-hiv/what-happens-hiv-drugs-body-and-do-missed-doses-matter
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
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Offline MarkB

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Re: Ritonavir and Darunavir
« Reply #9 on: November 15, 2024, 05:19:00 pm »
Thanks for the helpful reply, leatherman, and for the links.

The clinic eventually contacted me and told me there was no medical personnel available to advise me until Monday or Tuesday. The person I spoke to suggested I stop taking the new regime, go back on the old one, and come in next week for blood tests. They also said that if the rash hadn't begun to clear by Monday, to go to the emergency room straight away.

I wish they'd not been so cautious and had never put me on this new combination in the first place.

Regards,

Mark

Offline Tonny2

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Re: Ritonavir and Darunavir
« Reply #10 on: November 15, 2024, 05:20:33 pm »


             ojo.            @leatherman, oh man!, you are good.

@Jim Allen, A&E?…hugs

Offline MarkB

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Re: Ritonavir and Darunavir
« Reply #11 on: November 15, 2024, 05:25:47 pm »
@Tonny2 -- A&E means 'Accident and Emergency'; it is the term used in the UK for what I believe is called an emergency department or emergency room in the US.

Offline Tonny2

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Re: Ritonavir and Darunavir
« Reply #12 on: November 15, 2024, 08:12:44 pm »



                ojo.              Thanks Mark. Here in the USA. A&E is a cable channel (tv) and I got confused.… Well, as you can see, we all here believe that you will be OK going back to your previous treatment but, like Michael said, check your viral load in the near future just to make sure… Good luck and please keep us posted. And try some antihistamine medication for your rash. I hope it gets better.. Usually the only rash I would worry about is with abacavir, but I know that everybody’ reacts different to some medication… Hugs

Offline MarkB

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Re: Ritonavir and Darunavir
« Reply #13 on: November 16, 2024, 06:40:45 am »
I feel really ill today. The rash is no better and my temperature is up again. I've been told not to go to A & E as there is no point, also that no doctor is available to see me until Monday. Maybe this is my time.

Offline Jim

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Re: Ritonavir and Darunavir
« Reply #14 on: November 16, 2024, 07:20:00 am »
I feel really ill today. The rash is no better and my temperature is up again. I've been told not to go to A & E as there is no point, also that no doctor is available to see me until Monday. Maybe this is my time.

Sorry to hear that you are feeling unwell. Temperature sounds like an infection, plenty of fluids and rest and if things get bad go to A&E regardless of what was said.
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