Reduced-drug treatment (Biktarvy)

[Bucklandbury]

RE: https://www.aidsmap.com/news/mar-2021/four-days-three-days-treatment-regimen-still-looks-effective-after-two-years
 
https://www.aidsmap.com/news/oct-2023/reduced-drug-treatment-becoming-common-paris

==
 
I want to reduce my Biktarvy pill burden. I know this board is not my ID doctor, but any experience "out there" as to why going from an every day BIK to one every other day might be a bad idea in the fall of 2024?

I have no know HIV resistance based on typing done back on me in March 2021. I have been undetectable since, and I have never missed a pill since.

[leatherman]

might be a bad idea

I read through those reports and had some thoughts. Of course these thoughts are based on my experiences of a vast number of medications, various resistance issues, health and age over my 40 yrs living with HIV.

First, all I could think at the end of that read was sadness for those 20-something people who had virological failure and resistance mutations. Been there done that. Once you have to start mixing and matching personalized regimens you open yourself up to new long and short term side effects. Plus there could be a time factor of still rising viral load while getting the right regimen to work.

next are all the other factors that could influence this:
your age- as you get older the chances of a new regimen having negative side effects rises
your current health- other conditions could increase med side effects. possible virological failure could be increased and that could further negatively influence your health.

Being crass, then there's a money issue. Are you having to pay out of pocket for your meds? Would the new FOTO plan save you on your health care costs? Or do you have no out of pocket cost? So while FOTO could save money, you wouldn't experience that benefit - and that plan has another potential negative of exposing you to the chance of virological failure.

For myself, 62 and in great health, having gone through about 2 doz HIV meds, virological failure multiple times, resistance issues, finally on a great regimen for 15 yrs with no neg side effects, and my meds covered through medicaid? No way will I try FOTO. Never f-up a good thing is my motto!

If I was 42 in good health, on maybe my second regimen, no failures, no resistance, no side effects, 10 yrs UD, but paying meds out of pocket or a copay with insurance? Probably take up FOTO in a hot minute.

[Jim Allen]

RE: https://www.aidsmap.com/news/mar-2021/four-days-three-days-treatment-regimen-still-looks-effective-after-two-years
 
https://www.aidsmap.com/news/oct-2023/reduced-drug-treatment-becoming-common-paris

This is the QUATUOR & BREATHER studies.

We have a thread on this if interested: https://forums.poz.com/index.php?topic=72799.msg
Caution over French study only taking ART 4 days a week: https://i-base.info/htb/36517

any experience "out there" as to why going from an every day BIK to one every other day might be a bad idea in the fall of 2024?

The potential drawbacks and issues of FOTO haven't changed in 2024. Personally, it would not benefit me and I am too risk-averse, I have a long way to go and the last thing I need is additional resistance—My thoughts are similar on dual therapy given the data.

However, it works well for some people, and of course, it is always a case of weighing up personal potential benefits vs risks, anyhow, to my knowledge, I'm not sure anyone on the forum is still doing FOTO but I might be wrong and @harleymc did mention they would discuss the option with their doctor.

Take it easy, keep us posted.

[daveR]

I don't see where one pill a day is a burden, compared to years gone by. I know it is three drugs in one but my personnel thoughts are to play it safe and maintain the drug levels daily. Many people require multiple pills, my wife takes three individual pills for her blood pressure compared to my one pill daily for HIV. I will wait and see what the next generation of medication is like, I read that Gilead are now developing a single pill two drug regime that is taken once per week. I would be more inclined to wait on that completing phase 3 trials as it has been developed specifically to be taken in that manner. The current drugs were developed to be taken daily.

Just my two cents worth
Dave

[Bucklandbury]

When I say pill burden... it's not a burden like that. I am thinking of what occurs at the cellular level. ARVs are known to cause certain disregulation in the mitochondrial action, for example. Why expose yourself to that when it's not necessary? If three fewer pills per week can do the same as seven -- then why not?

The past is gone, and the future is not promised. I concentrate on the now with what I can do.

[Jim Allen]

When I say pill burden... it's not a burden like that. I am thinking of what occurs at the cellular level. ARVs are known to cause certain disregulation in the mitochondrial action, for example. Why expose yourself to that when it's not necessary? If three fewer pills per week can do the same as seven -- then why not?

The past is gone, and the future is not promised. I concentrate on the now with what I can do.

 

That clarifies a lot, to be honest, when you mentioned pill burden I had the same thoughts as Dave.

Mitochondrial damage, HIV itself does that and certain meds, treatments, exposures and also certain HIV meds can, although with the current daily HIV meds, despite concerns it's shown we can live a long and healthy life. I think the reasons for and against FOTO are clear and if you go with FOTO, please do keep us posted.

Personally, in the future, I could be hit by a bus tomorrow, fall down the stairs or develop an unrelated to HIV or treatment illness and die, in terms of HIV generally speaking I think the one pill a week or tailored daily dosages and non-superior long-lasting injectables are the next developments.

Take it easy, best, Jim.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830696/