Switching from Triumeq to Dovato or Biktarvy

[walkingpoz]

Hi guys, I’ve been on Triumeq for almost 10 years and have no noticeable side effects (I do have occasional insomnia but I always thought this was due to anxiety or stress etc.) and have been undetectable ever since. Now my clinic wants to switch me to Dovato (this has been suggested to me for more than a year now but I always declined - because I used to take Isentress and had a few blips then and wasn’t sure if it would work as well in me as in someone who is treatment naive). The reason they wanna switch me away from Triumeq is because of the cardiovascular risks associated with the abacavir component. Now I’ve decided to switch away from Triumeq but I am indecisive about whether to switch to Dovato or Biktarvy. I’m leaning towards Biktarvy because personally I would feel more comfortable with a 3-drug regimen and emtricitabine has a longer half life than lamivudine.

Now switching to Dovato would be straightforward as the 2 components are already in my system. But how is it with Biktarvy with dolutegravir’s molecular structure being so similar to bictegravir’s, and lamivudine’s being so similar to emtricitabine’s? Would it still take a few days until steady-state plasma concentrations are achieved or do the similar chemical structures help in this case?

[Jim Allen]

Interesting topic.

Now my clinic wants to switch me to Dovato (this has been suggested to me for more than a year now but I always declined

Same here but for the past 18+ months. Dovato isn't a superior treatment, and as for the ABC, it's been known for years; I'm still not too worried, although as I am getting older, I am now looking to switch as well; no rush, though, and it will not be Dovato. 3TC's short half-life and the fear of defaulting to monotherapy down the line are among the reasons.

I’m leaning towards Biktarvy because personally I would feel more comfortable with a 3-drug regimen and emtricitabine has a longer half life than lamivudine.

I'm sticking with HAART as well. I've outlined in more detail the why and discussed it in two recent threads:

https://forums.poz.com/index.php?topic=77560.0
New HIV drugs with a higher resistance risk should be classed as inferior

https://forums.poz.com/index.php?topic=77510.0
Experts recommend statins for all people with HIV aged 40+

Biktarvy is a solid drug, although not for me. I was on Truvada in the past, great for millions, but didn't agree with me and although Biktarvy contains the updated version*, I'm still going to give it a miss. *(emtricitabine/tenofovir alafenamide)

If you don't mind me asking how has your clinic reacted to you rejecting duo therapy and wanting Biktarvy?

Now switching to Dovato would be straightforward as the 2 components are already in my system. But how is it with Biktarvy with dolutegravir’s molecular structure being so similar to bictegravir’s, and lamivudine’s being so similar to emtricitabine’s? Would it still take a few days until steady-state plasma concentrations are achieved or do the similar chemical structures help in this case?

So... if you are switching one day to the next, the concentrations of drugs should consistently stay within therapeutic limits. Is that the question? Have you asked your clinic this question, and what did they say?

[Jim Allen]

Anyhow, I hope you can switch to something you are happy with. Remember that you are the boss of your healthcare, and keep us posted on how you get on.

[Tonny2]

                 ojo.               I wish I were in n that dilema of swishing from one pill to a different pill. Due to my history of resistance I still had to take lots of pills a day. I’m still alive though… I think that three medications is better than two, but that’s just me. I like Jim can’t handle tenofovir, I’m Allergic to it… please keep us posted and good luck with your decision.

[walkingpoz]

Thanks for the replies.

The clinic is ok with me wanting to switch to Biktarvy and I shall switch once I’ve used up the remaining Triumeq pills, which I still have a lot of. Will keep you guys posted.

[Tonny2]

          ojo.              Hello there!… i’m glad that you decided for the medication. I am allergic to abacavir I remember that after taking it at night time I woke up, and I look like the pink panther. All pink, because of a bad rash, plus my skinny legs definitely I look like the pink panther… good luck

[walkingpoz]

Hi guys little update and question about blips. Switched from Triumeq to Biktarvy 6 months ago and having no side effects. However for the 10 years I’ve been taking Triumeq I never had a detectable viral load (less than 20 copies) and now on Biktarvy my last week’s test showed a viral load of 30 which I hope is just an isolated blip. I read about what could cause a blip and learned that a cold or flu could cause one. I had a cold at the time of the test. Does anyone know anything about the mechanism of how a cold could cause an HIV viral load blip? I couldn’t really find anything about this online.

[Jim Allen]

Switched from Triumeq to Biktarvy 6 months ago and having no side effects.

Excellent, glad to hear things are going well.

now on Biktarvy my last week’s test showed a viral load of 30 which I hope is just an isolated blip.

30 copies is not even a blip, it's fully suppressed and you just switched so it could be just this and the release of some defective copies from the viral reservoir. *1

Now, as for it being isolated, if they had monitored you every day I would put money on it that in the last 10 years you or anyone living with HIV would have had plenty of "micro blips" detected

I read about what could cause a blip and learned that a cold or flu could cause one. I had a cold at the time of the test. Does anyone know anything about the mechanism of how a cold could cause an HIV viral load blip? I couldn’t really find anything about this online.

Yeah, so the cold and blips, you will find it being mentioned but without references and just in passing.

Did you ask your healthcare provider this and if so, what did they say?

To my knowledge, (happy to be corrected) there are no studies specifically into HIV viral load and why co-infection with the common cold (rhinoviruses, coronaviruses, adenoviruses and enteroviruses) could cause an increase in VL. I suspect the mention of it is just clinical observations and there simply was no need or use for specific studies, or reports as the effects are not a clinical concern. 

As for the mechanism, my limited understanding was that infections lead to immune activation, thus, increasing HIV replication and the viral load, but this isn't very relevant nowadays in the treat-all era and the current meds. The Swiss statement in 2008 initially had a caveat about certain co-infections that later got dropped as more was known. 

Of course, there are plenty of studies both observational and some controlled trials regarding viral load mainly without ART and other more major co-infections such as TB, STIs, and Hepatitis, pre-2005 and the 90s but a lot has changed since then, I've included some references but take whatever they say with a large pinch of salt. *2

Anyhow, I'm not sure if any of the above helps but prehaps it points you in the direction or someone else will chime in with some specific knowledge + reference I missed.


1*


Prof. Fiona Lyons (HIV in 2024)
https://forums.poz.com/index.php?topic=77637

Low-level VL linked to defective copies released from viral reservoir
https://forums.poz.com/index.php?topic=77301

Reporting VL below 200 - “harmful medical practice”
https://forums.poz.com/index.php?topic=77575

"What’s All This Fuss I Hear About Viral “Blips”?

Blips
http://i-base.info/guides/changing/viral-load-blips

Viral Blips Don't Raise the Risk of HIV Treatment Failure
https://www.poz.com/article/viral-blips-raise-risk-hiv-treatment-failure

Spanish study gives reassurance, small HIV blips do not predict treatment failure
Teira R et al. Very low level viraemia and risk of virological failure in treated HIV-1-infected patients. HIV Medicine, online edition. DOI: 10.1111/hiv.12413, 2016.

What’s All This Fuss I Hear About Viral “Blips”?
https://academic.oup.com/cid/article/70/12/2710/5573119

Q&A on persistent low-level viremia.
https://www.healio.com/infectious-disease/hiv-aids/news/online/%7B8373ca63-674d-4015-ac35-f4da653c7415%7D/qa-understanding-persistent-low-level-viremia-in-people-with-hiv


2*
Anderson RW, Ascher MS, Sheppard HW, Direct HIV cytopathicity cannot account for CD4 decline in AIDS in the presence of homeostasis: a worst-case dynamic analysis. J Acquir Immune Defic Syndr Hum Retrovirol 1998,  17, 245-252.

Bentwich Z, Kalinkovich A, Weisman Z, Immune activation is a dominant factor in the pathogenesis of African AIDS. Immunol Today 1995,  16, 187-191.

Agegnehu, C.D., Techane, M.A., Mersha, A.T. et al. Associated Factors of Virological Failure Among People Living with HIV
https://link.springer.com/article/10.1007/s10461-022-03610-y

Goletti D, Weissman D, Jackson RW, et al. Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation. J Immunol. 1996;157:1271–1278.

Schacker T, Zeh J, Hu H, Shaughnessy M, Corey L. Changes in plasma human immunodeficiency virus type 1 RNA associated with herpes simplex virus reactivation and suppression. J Infect Dis. 2002;186:1718–1725.

 Kublin JG, Patnaik P, Jere CS, et al. Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: a prospective cohort study. Lancet. 2005;365:233–240.

Kizza HM, Rodriguez B, Quinones-Mateu M, et al. Persistent replication of human immunodeficiency virus type 1 despite treatment of pulmonary tuberculosis in dually infected subjects. Clin Diagn Lab Immunol. 2005;12:1298–1304

Anzala AO, Simonsen JN, Kimani J, et al. Acute sexually transmitted infections increase human immunodeficiency virus type 1 plasma viremia, increase plasma type 2 cytokines, and decrease CD4 cell counts. J Infect Dis. 2000;182:459–466.

Baeten JM, Strick LB, Lucchetti A, et al. Herpes simplex virus (HSV)-suppressive therapy decreases plasma and genital HIV-1 levels in HSV-2/HIV-1 coinfected women: a randomized, placebo-controlled, cross-over trial. J Infect Dis. 2008;198:1804–1808.

Celum C, Wald A, Lingappa JR, et al. Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2. N Engl J Med. 2010;362:427–439.