Second line of tre treatment with Dolutegravir

[kuttakamina]

My doc prescribed me dolutegravir/atazanavir/ritonavir last week.

I was on atripla for 6 years (started in 2010) with a very good outcome. Then I listened to Luc Montaigner about the virus on the Internet and stopped taking atripla. This was in mid-2015. Now the doc is saying I'm resistant to all nrti and nnrti meds

I've read that atazanavir gives you yellowing of skin and eyes so I want to avoid taking it. Is there another less toxic combination that can be used with dolutegravir?

Cd4 is in double digits and VL close to 200000.

Thanks for your response

Kuttakamina

[harleymc]

Well you read wrong. One of the listed side effects that may occur is jaundice. It's not guaranteed that you get it.

[CaveyUK]

Hi

Yellowing of the eyes is estimated to affect 10% of people taking atazanavir. That translates to a 90% chance it won't happen.

I'd respectfully suggest that after stopping therapy and finding bad news about resistance, that given your VL and double-digit CD4, the critical thing is to simply get back on treatment and get your VL undetectable and immune system back in the right direction. If there are any issues with the atazanavir then deal with them when they happen rather than worrying in advance.

You should also be on precautionary antibiotics such as Bactrim/Septrim given your CD4 count. Make sure those have been prescribed also.

[Jim Allen]

I do agree it seems both the 2015 issue that caused this was reading or listening to things (rubbish) online and now (2017) reading online is the cause for undue stress over a "what if".

Take the meds, work with your doctor.

Jim

[kuttakamina]

Thanks for all your responses. I'm a US citizen living in a developing country where not all meds are available. For eg, I don't know if Triumeq is an option for me but it's not available here.

On a different note,  I don't understand what resistance to drugs is. I had read a while ago, that if you quit or become resistant to certain meds, and quit taking the meds, after a while hiv goes back to being the wild type and in theory you can reuse the original meds again. Is that true?

Now here's the big puzzler. While on atripla, I took full dose of 1/day in 2010, then in 2011, one day on and one day off, that to only half a pill, then in 2012 through 2014, one day on two days off of half a pill, then in 2015, one day on three days off of half a pill. Every six months I'd get a cd4 and they were on the increase since 2010, and the highest were in June 2015 with 880. How do you explain this?

Was this half tablet even working after 2012 onward? I was very healthy during this time. Then I heard the noble prize winner discoverer of HIV in a documentary saying that HIV can be overcome with good nutrition, good antioxidants, clean drinking water etc so I quit atripla in June 2015.

Then in Dec 2015 my cd4 had died on dropped to 290. I thought they fell by  100-200 each year?

Thoughts?

[Jim Allen]

Building resistance can take time, and it does happen.

Incorrect or intermittent adherence like yours is one of the leading factors in virologic failure rates of course in many cases it does lead to drug resistance. Its not a mystery same goes for many other viruses.

The treatment does not give you CD4's, it just suppresses the VL and CD4's will vary between monitoring. If i checked mine in the AM vs PM today there could be a 100 count difference - nobody really cares about CD4's from snapshot to snapshot, hence reduced monitoring of them nowadays once someones VL is suppressed by the meds. We also know now CD4's does not measure all of the damage being done from incorrect or not treated HIV.

I am sorry that you have found yourself in this situation, its a shame that the person you followed in question did what he did and a lot of hurt in the world has come from it and will continue long after his recent death. Nobal prizes from the past for one thing does not make an expert for life or someone infallible. Science  moves on and the lesson here is the only way to suppress HIV is with medication.

Wishing you well and all the best, I mean that and keep us posted on now you get on with the new treatment , I hope this time adherence will not be a an issue.

Jim

virologic failure
https://forums.poz.com/index.php?topic=66234.0

Experts debate treatment - debated ended.  (To my comment CD4's does not measure all of the damage)
https://forums.poz.com/index.php?topic=51849.msg719533#new

[paintedroom]

Adherence,Adherence,Adherence - make that your blessed trinity.

[Kangaroo]

My doctor prescribed me Tenofovir and Lamivudina with Dolutegravir.

In my country this is the first line of treatment, I don't know much but my immunologist that is also academic told me it has less side effects and less toxicity than efavirenz... it became the first line thanks to a petition of a association for well-living of the poz population here to the ministry of health.

I just started so I still don't know if it works.

[Jim Allen]

Hi

Well sounds good, I'm sure your next labs show reduction in black.
When is your next follow up planned?

Jim