Shortage of Estiva in my country; was off it for several weeks until today

[cadillac_jack]

Hi Poz.com,

I apologize for any ignorance in my questions as I'm pretty new to this and it's hard to get good advice here in Cambodia where I work.

But thank you very much in advance for any guidance you can provide!

I have two questions:

1) I was diagnosed with HIV about a year ago and was put on Truvada and Stocrin for about six months, until Cambodia stopped importing Stocrin so I had to start taking Estiva 600 instead...

Then about 3 months ago, Cambodia stopped importing Truvada so I had to switch to TENO-EM...

Were either of these switches dangerous/meaningful in any way?  Regardless of what the combination was I never missed a day and always took both of the pills.

2) After being on Estiva/TENO-EM the past few months, the Ministry of Health screwed something up with a new importation law and caused a shortage of Estiva.  Not only do none of the pharmacies have it, even the Ministry of Health itself was out.  So the past several weeks I've only been taking Truvada...

Luckily, I am finally back on both pills as a friend brought me some from Bangkok.

How much danger was there being off of Estiva-600 for several weeks while only taking Truvada?

Thanks again very much for your help!

[Expat1]

You were taking brand name medications.  They were replaced with generic versions.  They are the same molecules.  And the generics are equal to the branded medicines.

When the government ran out of the one pill, you should have added another pill.  The 2 drug pill of TenoEM or Truvada, is not sufficient to suppress HIV long term.  My advice to you is to take the medicine for about 2-3 months and then get a Viral Load test.  If undetectable, great.  If not you might need to start second line therapy which would probably be AZT/3TC and a boosted protease inhibitor. 

Is genotype testing available in Cambodia?

Can you get to Bangkok to the Thai Red Cross Clinic?

It is unclear if you rely on government funded meds or can purchase them on your own. 

If this ever happens again.  You need to have a 3 drug treatment. A boosted protease inhibitor can switch out temporarily with either the Truvada or the Efavirenz. 

Did the Doctors give you any sort of option?

[cadillac_jack]

Thank you so much!

And, yes, I pay for my own meds and can easily get to Bangkok any time.

That was my first question, "Can I buy it in Thailand?", and I would have gone 3 weeks ago to buy it, but the doctors here told me Thailand won't sell to foreigners any more and only to locals.  And I foolishly didn't research it any further (obviously, my doctors here were wrong).

I'll follow your advice to the T.  I really appreciate it!

[Expat1]

Yes you can get meds in Thailand.  Any private hospital will sell them just go see a doctor in out patient department. Cost is about 2-3 times the cost at the HIV clinic Adams Love.

Thai Public Hospitals also have your meds, but can be a bit burdensome. Long waits.  May limit you to a 2 week supply.  ETC.

Or go to the Thai Red Cross Clinic,  bring your prescription from your Cambodian Doctor, and they will issue you the meds.  See the link Adams Love.

www.adamslove.org

Look at website. 

[Expat1]

If you are near a land border, the Bangkok Hospital chain has the meds.  They also have a branch in Phnom Phenn.  So can probably get the meds there too.  And those would be purchased separately from the Cambodian National Supply.  There is a branch in Trat Province. 

One of my Thai Friends had to stop meds because he got sent to prison for a a drug offence for 42 days. (No hiv meds in Thai prison!)

When he got out, the NGO doctor here, just restarted the same prescription and waited 3 months to check for resistance.  He takes the same meds as you.  And after 3 months he was again undetectable.