Looking for advice re treatment please.

[AverageJoe]

Hello to all,

I'm an infrequent poster, but as always would like to thank all contributors to this forum which has helped me immensely over the last few years since diagnosis.

So I have enrolled into the START study (I just met the deadline before it closes).

I have been randomised for the treatment arm. Tomorrow I am meeting with my consultant to discuss treatment options.  Initial conversations suggest that I can choose between Darunavir/truvada ( and I guess Norvir booster), or Raltegravir/truvada.

I understand dosing options will vary between the two regimes, ie raltegravir may be twice daily, but I am not too concerned about this.

I guess I am looking for a bit of anecdotal and scientific input as to which will be the most tolerable option.

Since diagnosis in early 2010, my cd4 have been consistently about 500-600 and my VL between 3000-6000.

I have partial resistance to some NRTI,s and mixed tropism result.

Any advice appreciated , also anything I should think of discussing with my consultant  on Wednesday prior to agreeing on a regime

Thanks all!

James (in London UK)

[newt]

With some NRTI resistance I would go for darunavir, since the strength of this is likely to overcome mild NRTI resistance.

Raletgravir has the benefit of not really raising cholesterol. If you do choose raltegravir, and it doesn't work out, you can always switch to darunavir, but do note that newer integrase inbitors are likely to be a main choice of therapy for many in years to come, and getting resistance to raltegravir now because it can't quite top up the nukes may compromise your long term treatment choices.

It really does depend on the NRTI resistance in question, the above.

Either are generally regarded as low side effect combintions, so it's probably horses for courses here.

Good luck

- matt

[Miss Philicia]

Either option is acceptable and a bit of a flip of the coin on which I would choose myself, and fyi I have taken all of those drugs listed.

All things being equal I'd say, if you are hinting at side effect potentials, you have this to consider:

Yes, you will need a norvir booster with the darunavir/truvada choice. IIRC it's only 100mg so hardly counts as a drug here. Some say they get diarrhea from this but most do not, and infrequent diarrhea is easily treated by upping your fiber intake (which is a good thing anyway for general health reasons) or taking imodium when neeed.

On the other hand, some people have sleep issues from raltegravir (IIRC the figure is something like 4%) but obviously the vast majority do not.

There are some reports that a protease inhibitor based regimen will raise cd4s quickly, and others that say an integrase inhibitor will do it quicker -- frankly I don't think there's enough data to clearly say, and anyway your cd4 count isn't low so that's not a huge consideration.

I'd probably take my chances with diarrhea over sleep issues, but in either case the chances of side effects are quite low. Also that would allow you to only take meds once per day.

[AverageJoe]

Thanks for your considered responses guys.  I will update you after my appt on Wednesday.

James.

[Ann]

James, I'm on the darunavir (Prezista)/Norvir/Truvada combo and overall, I like it. I had an increase in diarrhea in the first week/ten days, but it all quickly went back to normal. You're supposed to take it with a bit of food - a snack will do - so I take it with my afternoon meal as it makes it easier to remember. If you're a regular breakfast eater, that may be a good time too. Whatever meal you have at roughly the same time every day would be best.

I'm really happy to know you're taking part in the SMART study.  Far too many people (IMO) with really good numbers like yours (+500 CD4,  low VL) are whacked straight on to the meds these days without being part of a study, when we really don't know if there's actually any benefit to doing this. So thanks for taking part in finding out!

[AverageJoe]

Ok guys,

So I had my appt. I'm going to be starting the Darunavir/truvada/Norvir regime in early January. I'm going till wait till then as think it will be a boozy Christmas and want to start with a clear head!

Thanks for your advice and support!

I wish you all a happy Christmas.

James.

[Ann]

Sounds like a good plan, James. Waiting another couple weeks won't make any difference in the greater scheme of things. Daily adherence is extra important in the first month or so and we wouldn't want you forgetting a day, so early on, due to being too pissed or hung over. Enjoy the holidays and get down to it in the new year.

Have fun!