What If I skip one med for 10 days due to its availability?

[Gorch19]

Hi. I just started treatment 30 days ago. My social security at my country covers HIV treatment but some times there are meds shortage. I learnt it by the wrong way. My treatment includes Truvada+Efavirenz, by the time of re-supply I just got Truvada and who knows when I'm going to be able to get Efavirenz. I just started to get a back up supplier, but in the meantime, I don't know what to do. Its hard to get last minute specialized consoulting at my country and I travel a lot.  So, i have two optios:
1.  Should I just take truvada
2. Should I just suspend both meds til I get Ef+Tr (10 day maximum)
3. Is there any other option?

CD > 250, copies < 10,000

I appreciate your thought and advises.

G.

[Ptrk3]

I would advise option 3, since I would not advise the other two without speaking with a physician.  I certainly don't think it's a good idea to stop taking meds for 10 days, nor do I think it's advisable to take a partial component of a "cocktail" retroviral medication.

I would ask your doctor if there was an HIV/AIDS support system locally that could provide you with the necessary medications to keep you compliant with your regimen, or maybe contact and tell the supplier of your situation (perhaps, the supplier could send you a rush supply, especially if it was the supplier's mistake in getting you the efavirenz).

[eric48]

suspending one pill while initiating treatment is calling for trouble.

The pill that you are lacking is: Efavirenz 600 mg (that you take with Truvada)

you should be aware that the use, as first line, of efavirenz 400 mg (with truvada for exemple) as been approved by the WHO.

There is no loss of efficacy.

If you have enough stock (or can borrow some stock some where) you can discuss with your doctor about how to spread your Efavirenz and still be within the WHO recommended framework.

[mecch]

Is there ANOTHER 3 component treatment that IS available to you now, immediately, as a stop gap measure.
Which 3 molecule treatment, if any, is always garanteed to be available to you?
What do other HIV+ people in your country do in this exact situation?

[Gorch19]

Thank you for your quick response guys
Im new in this stuff. Specialized doctors are hard to get at las minute (I mean, after I was diagnozed, I coud get my apoointment 6 months after and start treatment 9 months after), unless you have the money though. I still recilent who to tell about, And it has been a hell battling by my self. Anyway (I hate sound like Whinin).


The issue is that I dont know many answers to your questions.
For example, what do you mean with 3 molecule treatment? 

I never thought that it would be this hard to get meds, not in any farmacy ar on sale (Now I know). These information you just gave me worth gold to me. I will keep you informed what could I do to fix this mess i got into.

Hughs from Mexico

[eric48]

Since you had a initial viral load that was in the low end (<10.000) you may want to consider this a favorable situation for suppressing the viral replication even if using only a dual-therapy (Truvada contains TDF+FTC)

There is only limited knowledge, but there is some... So you are not in unchartered territory. This has been done, tried and published before.

Rapid plasma viral suppression in naive HIV-infected patients with high CD4 cells and low viraemia initiating a dual nucleoside reverse transcriptase inhibitor

http://jac.oxfordjournals.org/content/early/2014/10/11/jac.dku265.full

20 patients with a virologic profile similar to yours, new to treatment, have been treated with Truvada only. this small trial was named BiNuke. The CD4 requirement was CD4>300, so you are not far from that

The treatment outcome was very good. There might be other similar trials out there, I wouldn't know...

In your very specific case (low VL <10.000), using Truvada only might be doable, without putting you into harms way.

You should discuss this with your doctor before considering this option.

[Gorch19]

Thank you so much for your thoughts
Today I was calling every farmacy and institution in my city in order to get some advise, counseling, directions or whatsover. I was finally able to get 15 pills free from an NGO. I will split it to make it last in 400 mg dose. This will give me plenty of time to get my stuff together.
Thanks again for your good vibe
G.

[Ptrk3]

Sounds like a good start, but do check with a doctor or pharmacist to make sure that the "splitting" will work out fine in terms of efficacy.

[Jim Allen]

Hi

Its good that you got the support from the NGO and managed to get 15 pills.

But do check with a doctor on "tinkering" with your medications, there are lot of theories and maybe's and tests and even some trials with regards controlled playing with dosing, however none of that means you should be considering DIY'ing your HIV medication.

The only correct and sound advice here is talk to your doctor before you do anything. Tinkering with HIV meds based on something someone once and was  okayish for them in controlled situation does not make it a good idea to try it at home, its is a bad idea that may end in tears and your the only one who has to live with the consequences!

Check with your doctor.

Jim

[mecch]

I still recilent who to tell about, And it has been a hell battling by my self. Anyway (I hate sound like Whinin).


For example, what do you mean with 3 molecule treatment? 

Hi. I see you got a solution worked out.  I will respond to the two points above. 

1 - yes I was asking you what HIV+ people in your location do in the situation you are in.  I guess I am reading that you aren't talking to anyone about this.  Well, I suggest you look around on the internet and see if there are any HIV+ groups online. Because its people adapting to the local situation who are going to know all the options for dealing with such things.  You don't have to tell your friends or family if you want to talk to other HIV+ people in Mexico.

2 -     a 3-molecule combination means a treatment with 3 drugs. This has been the standard kind of HIV treatment for years.  Its not the number of pills, its the combination of 3 drugs.  Sometimes it used to be referred to as "tri-therapy" - 3 -  Your truvada is 2 drugs and the efavirenz is the 3rd. There are many kinds of 3 - drug combinations available.

I was surprised that a country (like Mexico!?) would have truvada but run out of efavirenz.  That is why I thought i might be a good idea to figure out if any 3-drug combination is pretty much always available in Mexico.  Doctors or HIV+ people might be able to tell you that.

Another thing to eventually keep in mind - when it seems like supply of HIV drug is pretty good - try to build up a stock of 1 month - so you can have it if the state supply disappears for a moment.  To tide you over.

Above - eric was showing you research on 2-drug treatment. Its research and highly controlled. Since it seems like you see doctors rarely and briefly, this seems like a terrible idea for you to even consider.

[eric48]

good to ear that you could find usefull ressources.

Should you want to educate yourself and be ready for discussing the practical aspects of the World Health Organization latest recommandation (Nov. 2015) with your doctor, I would recommend this:

Better Late Than Never: Efavirenz Dose Optimization
http://www.treatmentactiongroup.org/tagline/2014/spring/better-late-never-efavirenz-dose-optimization

This is by tim Horn, a long time value added contributor to this forum.

The document is a bit old and the reduced dose has indeed been approved by WHO since.

Should you need more, just ask

[Jim Allen]

Gorch19, have you manged to speak to a doctor about the break/reduction in treatment? Its been a few days since we last heard from you.

The only one to give you correct advice on this would be your doctor.
Don't go trying to do this by yourself certainly not by what you read online.

Hope your doing okay.

Jim

[Gorch19]

Hi guys
Im working with all your advises (and writing it), so I can discuss it with my doctor. Next appointment is just before xmas. My first follow-up analysis are goin to be perform around that date, so up to this moment I dont even know if meds are workin as suposed to do or if im getting a kidney/liver poisonig. Appoitments are hard to get and not so flexible. Am learning to build patience.

Off-topic
I was getting bug-bite kind itchy spot which started in my tights and they have spread to all my body. Since Im getting hiv meds, this condition has improved. I've got prescription for allergies and fungus but it hasnt stopped yet. Ive read that skin problems are quite common. Have u struggle with tis particular issue?

[Jim Allen]

Skin problem are common enough for everybody, even the HIV negative population.
Keep working with your doctor.

Jim 

[eric48]

removed by me... i posted in the wrong thread...