Switching from boosted Reyataz to Viramune Question

[egello]

Ok, now I am confused as to how to go about making this switch...

So my doc this morning told me that I should take one Viramune for one week while still continuing my boosted Reyataz and Truvada combo, and then take two Viramune and drop the boosted Reyataz after the initial week.

Just now, I read this article that was just recently published that says not to combine Reyataz and Viramune due to toxicity.

http://74.125.95.104/search?q=cache:4u2heUWSzjUJ:www.poz.com/articles/hiv_reyataz_atazanavir_761_15173.shtml+viramune+vs.+boosted+reyataz&hl=en&ct=clnk&cd=6&gl=us&client=firefox-a

Is this too new of an article that he doesn't know about it? or should I follow his dosing recommendation?

Any comment appreciated


Also, Do I have to be much more strict with the exact time I take my meds now that I will be on Viramune than compared to boosted Reyataz?

[egello]

ok, so my doctor told me that it shouldn't matter, and that there are plenty of other patients of his that have done something similar like that... but he was not aware of that article i mentioned in my earlier post.

[BlueMoon]

I would say to follow your doctor's recommendation, as it isn't for a permanent regimen. 

I didn't see any mention of toxicity in the article that you linked, only that Reyataz and Viramune affect each other's blood levels.  Presumably the half dose of Viramune will compensate for the elevating effect of the Reyataz, and the additional drug in the regimen will compensate for the lowered Reyataz level.  I think that if there's any danger it will be that the lowered level of Reyataz can lead to resistance to that drug, or class of drugs.   

That is just speculation on my part though, and maybe someone more knowledgable will chime in here.

[shadowfluid]

I went from Viramune + Truvada on a thursday then switched to Reyataz, Norvir, Truvada....on a friday.  Doc said it was ok.  I guess every doc is different? I didn't die.

[newt]

The half dose of Viramune is to reduce the chance of side effects, and is normally done for two weeks, but one, two, with undetectable viral load, moot point perhaps. You normally get your liver checked before increasing the dose to full strength, just in case.

- matt

[egello]

I would say to follow your doctor's recommendation, as it isn't for a permanent regimen. 

I didn't see any mention of toxicity in the article that you linked, only that Reyataz and Viramune affect each other's blood levels.  Presumably the half dose of Viramune will compensate for the elevating effect of the Reyataz, and the additional drug in the regimen will compensate for the lowered Reyataz level.  I think that if there's any danger it will be that the lowered level of Reyataz can lead to resistance to that drug, or class of drugs.   

That is just speculation on my part though, and maybe someone more knowledgable will chime in here.

here it is...

http://www.aidsmeds.com/articles/hiv_reyataz_atazanavir_1667_15173.shtml

[Sydney]

Hi Egello,
I read the article, and I'd agree with BlueMoon.  On my reading, the recommendations relate to an ongoing combination regimen containing Viramune and Reyataz.  Your situation, however, is a short-term transition. The overall effect is a phase-out of Reyataz combined with a phase-in of Viramune that should (in theory) hold the virus in check through the transition.  And being on the half-dose of Viramune, even if blood levels are amplified somewhat by the Reyataz, should provide some safeguard against the risk of Viramune side-effects (liver and rash). 

You may or may not have read that recent prescribing recommendations for Viramune are that if there is a rash, the half-dose should be extended beyond the initial period, though not longer than 28 days.
http://aidsmeds.com/articles/1667_14879.shtml

cheers and keep us informed.