Just Switched to Isentress from Reyataz/Norvir (plus Truvada)

[sfpvguy41]

I started on Reyataz/Norvir and Truvada combo in March 2006, and it has been very successful for me.  Starting at 459 CD4 (nadir 377)  after feeling really tired all the time, VL 30k.  Now i am at 731 CD4 and undetectable since 9/2006 labs, with no side effects to speak of (maybe some loose stools, hard to say). 

I just switched today to Isentress/Truvada.  Why?  Three reasons:
1) My SF doc, who has a huge HIV practice, says it does great clinically.
2) It lowers the prescription count to 2, so I save on co-pays
3) I HATE having to worry about refrigerating Novir.  Sometimes I want to travel in warm tropical climates for days when access to a frig is unsure, and the temperature can be well into the 90s.  This can harm Norvir pills.  I hope with Isentress to free up my travel abilities.

I don't like 2x/day dosing, but my SF doc told me many of his patients were successful on 2 pills 1x/day.  For now I am going to be conservative and try to do 2x/day, and see if I can develop new habits and if having to take meds 2x/day affects my compliance, which has been probably around 98%. 

I'm interested in whether others have made this switch, and what is your experience in terms of any side effects, and how your labs look.  I'm not sure mine can look much better.  With the exception of high bilirubin, everything is quite good - CD4% is up to 40% now, so almost everything is "normal" including triglycerides, cholesterol, etc.

FIRST DAY NOTE:  Had some loose stool again today, not sure if it is related, or if it was my lunchtime chicken burrito.  Not much out of the ordinary. We'll see, otherwise I feel fine.  I'll try to post results over the next few months in case others are thinking of this switch too.

[HowYouDoin]

i made the switch from kaletra/truvada to isentress/truvada a few months ago and am doing well. Side effects are tolerable and feel great.. Numbers looks good too.

You will do fine..

Al

[Miss Philicia]

Actually a non-fridge formulation of Norvir has been FDA approved now for at least five months.  Saving money on co-pays is, of course, always helpful.

I've been on Isentress/Truvada for two years now: ~1300 cd4, 50%, undetectable, stable/normal "other" labs

[Inchlingblue]

I started meds with Isentress and Truvada and I'm doing great. I think it's an excellent combo, all things considered. The tenofovir in Truvada can bring on some kidney issues so it's important to monitor it but overall it's a great medication. I went undetectable very fast, in about a week or less (granted my viral load was only about 12K). Last time I checked my CD4s were 866. Lipids and everything else is fine. I do sometimes have low testosterone and low thyroid but this is not due to the HIV meds.

Keep in mind that Truvada (and Atripla) recently expanded the co-pay assistance programs so they cover the entire co-pay up to $200. each month.

LINK:


http://forums.poz.com/index.php?topic=33369.0

[sfpvguy41]

Wow, thanks, I didn't know about the non-fridge version of Norvir, no one ever told me about that including my Doc - I wonder why?

Anyway I had a little nausea the first day but it passed.  Now I notice firmer stool. Like a whole new world down there.  Not sure if this is something that will continue but loose stools has been an issue for a long time...so maybe it was due to the Norvir/Reyataz.

Otherwise no side effects and I feel fine.  Anyone have an experience with switching?

[sfpvguy41]

By the way those labs of 1300 and 866 CD4 and 50% are great!  Maybe mine will improve even more.

[madcowcorn]

i just started taking last night and woke up and threw up ;(
i tried the Atripla but threw up all day and felt dizzy and fussy in the head
im hoping this noucious effect will go away damnit
i was on Trizivir for 6-7 yrs with a tcell of 450-740 and viral of 200 so my doc wanted to change
but 200 isnt that bad
thanks for any thoughts advice in advance

[Inchlingblue]

i just started taking last night and woke up and threw up ;(
i tried the Atripla but threw up all day and felt dizzy and fussy in the head
im hoping this noucious effect will go away damnit
i was on Trizivir for 6-7 yrs with a tcell of 450-740 and viral of 200 so my doc wanted to change
but 200 isnt that bad
thanks for any thoughts advice in advance

You threw up with Isentress/Truvada?

[sfpvguy41]

It's not been 3 weeks and the only change i see for sure is in the bowel movements, definitely firmer.  It's like a whole new world down there.  Definitely an improvement over the loose stools with Reyataz/Norvir.

I went out last weekend and tied a few on and felt really really exhausted the next day, worse than the hangover I deserved.  I don't know if that's from the combo but my reaction felt "different".  Next time I'll see if I have the same reaction.

Looking forward to good labs!  Will post once I get them.

[sfpvguy41]

Well here it is December and I just gave blood for my labs, we'll see how they came out.  I met with my Doc.  And I am not happy.

First of all, I noticed a bad reaction if I am drinking.  The alcohol hits me harder, and is a nasty feeling - not fun just like anethesia, and I feel dumb.  The next day, I have a hangover which is mainly a dizzy feeling...lasts for a day.

Second, I often feel dizzy.  I am concerned that I'm less sharp than before, having been tested positive in 2002, I worry about dementia.  Now I don't know if it's the Isentress or that, or something else. 

Today the Doc upped my Wellbutrin dose, and gave me a trial of Nuvigil, which is otherwise for treating narcolepsy.  He said it has helped some with concentration and memory issues, which I feel like I am having.

The thought terrifies me.  My P.A., in a big HIV practice in SF, says he sees it more often and they can't do anything about it.  Are we all going to lose our minds?


So the question now is should iI go back to Reyataz/Norvir which seemed better at least as far as the alcohol effects go.  Or just wait it out (yes, I barely drink anything now!).  I'm going to see what labs say first, then decide.  Anyone have experience here?

[Inchlingblue]

I'm on Isentress/Truvada and I drink socially, basically a couple of glasses of wine or a beer or one cocktail and I have not experienced what you are describing. If anything it's the opposite, I hardly feel any effect from alcohol.

It could possibly be from other medications you are taking interacting with each other and with the alcohol?

As far as memory loss/dementia that's hard to quantify but overall, when comparing myself to others my age (48), whether they have HIV or not, I fare pretty well.

[Miss Philicia]

I agree with Inchling, in that I've been on Isentress now for three years and Truvada even longer.  I don't drink a lot, but from time to time, and yes to the point of inebriation.  Like Inchling I'm also around the same age (45) and my memory is fine (add to that I've been on HIV meds for over 17 years).  Bottom line is that I'd not be so quick as to lay the blame on Isentress.

[BM]

I find I cannot tolerate alcohol as much as I used to since starting Isentress. Three or four regular-strength pints of lager will induce a pounding hangover with hours of vomiting, followed by dry retching. I've essentially stopped drinking now since I was unable to take my meds for a long time when it first happened.

[Billy B]

My IDS advised me against drinking because of the stress it causes on the liver. He said that my meds were enough for it to handle. Now, he said I could smoke all the weed I wanted.......which I do!

[sfpvguy41]

My doctor said specifically that the dizziness is made worse by dehydration which is what happens when you drink.  He suggested a glass of water between each drink (always a good ideas anyway).  But I'm 100% certain this effect has happened after Isentress, and not before, it was the only thing I changed.

Responding to another point raised, yes I agree that it seems to cancel the (good) effect of the alcohol.  None of the fun, relaxing, carefree feeling just a stupid buzz and also I feel imbalance, like I'm likely to fall down.  I think that's why at first I didn't realize the difference and drank more and basically passed out (I never do this otherwise).

I appreciate other's experience!

[sfpvguy41]

My Cd4s went down, from 731 to 676.  However, the two labs before that were 672 and 662, so I've been in this range before.  CD4% went down, 40 to 34.  However, it was 34 in last February's labs, and 36 August a year ago.  CD8s way up:  to 1012 from 866, but were in the 900s before and were 1051 in May 09.

So as for CD4/CD8, I feel like it's worse than before with Reyataz/Truvada, but not by much.

Now for the good news:  Trigylcerides fell from 122 (a fairly common level) to 77, and bad (LDL) from 119 to 110, while good (HDL) went from 46 to 58. 

Meanwhile my kidneys appeared stressed from dehydration, but that could be explained by a night out for a friends birthday with too many cocktails the night before, and a "fasting" test the next morning (not much water).


Not sure what to make of this.

[Inchlingblue]

Not sure what to make of this.

It's all very good news. You are basically stable as far as HIV, doing very well. Your changes in CD4s and percentages etc are not clinically significant. I assume you're still UD.

As far as cholesterol etc., you are doing much better.

The kidney thing is something to keep an eye on. It could be what you said, dehydration from drinking. The Viread in Truvada can affect kidney function in some people. You don't mention what precisely the lab report showed as far as kidneys. I assume it was not too serious or your doctor would have flagged it and followed up.