Truvada and Lexiva...is this a good combo?

[HollyStar]

Hi everyone,

I'm on Atripla and because of several side-effects I'm switching to Truvada and Lexiva. This is the combo my ID doctor recommened. Truvada once daily and 2 lexiva in the morning and 2 in the evening. He was going to prescribe something else but because my CD4's are in the mid 300's, we couldn't go with that  as there could be kidney problems or something (I think it may have been Viramune or Reyataz, don't really remember). So is this a good combo? Because of the dosing of the Lexiva, I don't need the meds boosted with Norvir? I tried reading the drug info on here but I need someone to put this stuff in simple terms if possible. My brain is mush sometimes, lol . Any input would be great.

[BT65]

Holly, I took this combo at one time, and it seemed to be a good one.  The reason I no longer take it has nothing to do with its efficacy, it was because I was only taking it "when I felt like it," therefore developing resistance.  But, when I did take it regularly, it worked just fine and I don't remember having any disturbing side effects.

[Inchlingblue]

I was reading an interview with Dr. Joel Gallant in which they discussed the pros and cons of using Norvir to boost PIs and he said:

If you are one of those people -- I call them "ritonophobes" -- who just can't tolerate Norvir, even at 100 mg a day, Reyataz is probably the best PI to use. [If combined with Epzicom, not with Truvada]

With some of the other PIs, you either can't use them unboosted -- and that would be the case with Prezista, for example -- or you can use them unboosted, but you probably shouldn't. Lexiva [fosamprenavir, FPV, Telzir] is a good example, where unboosted Lexiva can lead to cross-resistance to Prezista.

You might want to ask your doctor why no Norvir boost?

LINK:

http://www.thebody.com/content/confs/ias2009/art53122.html

You can also ask Dr. Gallant's opinion by asking him on his website:

http://www.hopkins-hivguide.org/q_a/index.html?categoryId=9352&siteId=7151

[BT65]

Oh great, I hope this doesn't mean I may be resistant to Prezista.

[Inchlingblue]

What he says is vague as far as Lexiva: that you can use it unboosted but you "probably shouldn't."

I think whether one is already undetectable might make a difference, meaning if you go on it unboosted with a viral load it's probably riskier than going on it unboosted if one is already undetectable.

[HollyStar]

I'm confused, lol. I think one of the reasons that my doc didn't try Viramune or Reyataz is because my CD4 is low enough that it could cause kidney problems or something. I am undetectable though. I honestly can't recall a lot of what he said. I also did the med check on here for Truvada, Lexiva and Acyclovir and there were three moderate interactions. I'm supposed to start the new meds next week after I get my labs done, then I follow up with my doc in a month. Thanks for the info. It just might take a while to make sense of it.

[Tempeboy]

Hey Hollystar,

The manufacturers of Lexiva have just released a new warning about an increased risk of heart attack with this drug - http://www.gsk.ca/english/docs-pdf/Telzir_PA_English_Final_unsigned.pdf

Nevirapine has an increased risk of certain side effects (liver, kidney, rash) if started at with a CD4 count above 250 for women.

One of the drugs in Truvada can decrease levels of Reyataz in the blood - increasing the risk of devoping side effects.

You could ask your doctor about Isentress (Raltegravir) - now available first line in the US - very effective and safe to take with Truvada and has few side effects.  This combination involves taking one tablet twice a day.

Here is a cool resource for women with HIV - http://napwa.org.au/resource/treat-yourself-right

all the best

[Inchlingblue]

Holly Star: As Tempeboy said, Isentress/Truvada is a very good option for you. Since Isentress is a newer drug your doctor may want to keep it in the back burner for future use but it seems to be an excellent one.

There are many threads on here discussing it, you can search and read through them if you like.

I just started Isentress/Truvada recently (my first combo) and I am experiencing zero side effects. For now it is taken twice a day but in the future, maybe soon, it may be available as once a day.

It is a very potent drug but it does have a low barrier of resistance, meaning only one mutation and it won't work, so the important thing would be to make sure to combine it with two active drugs, which in your case Truvada seems to fit this bill and also to make sure not to miss any doses.

I think you can also ask Dr. Gallant what he thinks, I put his link in one of my posts above.

[HollyStar]

Inchlingblue, thank you for that link. I went ahead and posted a question. This is Dr. Gallant's response. Needless to say, I put a call in to the clinic today and asked why I'm not getting boosted with Norvir. My ID doc should hopefully call me tomorrow. Thanks again.



Lexiva and Truvada, is this a good combo?

Posted on Aug 8, 2009
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Hello, I have been taking Atripla for several months now and I'm going to be switching to Lexiva and Truvada in about a week, due to undesirable side-effects. My ID doctor considered Viramune or Reyataz at first but decided against it. My CD4 is about 339 and my VL is undetectable. My questions are, is Lexiva and Truvada a good combo? Should it be boosted with Norvir? And why would the doctor decide against the other medications? Thanks.

On Aug 8, 2009 Joel E. Gallant, M.D., M.P.H. replied:

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I think that Lexiva should always be boosted with Norvir to prevent resistance. Resistance to Lexiva can result in cross-resistance to Prezista, but you're unlikely to develop resistance with any boosted PI.

I generally prefer boosted Prezista or Reyataz over Lexiva, because there are more data for Prezista and Reyata. However, I have no objections to Lexiva, as long as its boosted.

If you have a question about this answer, you may post a follow-up question.

[Inchlingblue]

Thanks for updating us on that. Gallant is a very cautious doctor. , I have found that some doctors take more chances with treatment sometimes.  Gallant is one of the world's foremost authorities on HIV treatment. There's a section of his website that is open only to other doctors who ask him for advice, so whatever Gallant says carries a lot of weight.

You should also consider Isentress, as long as you can be adherent and don't mind twice a day dosing, it's a really excellent drug and doesn't require the Norvir boost. Lexiva/Norvir/Truvada is also good though. Why your doctor ruled out Reyataz and Prezista is vague, these are both good, Gallant even said he prefers them over Lexiva.

Let's put it this way, we should be grateful we have choices since there are those who don't.

[ARMANDO]

i started my treatment using truvada lexiva and norvir about 2 yrs ago and this was the first combo that brought to be undectectable!!!In the past 18 yrs i had tried so many combos with no results and with very bad side effects,so for me this combo is excellent!!

[HollyStar]

Hi all,

I just talked to my ID doc and I'm going to trust him on this one. He said that he still considers me to be treatment naive, even though I have been on Atripla, but I didn't fail the combo. And, being as my VL was extremely low to begin with (before meds), he thinks that the unboosted Lexiva should be fine. He also said that a lot of people have trouble with Norvir as it can make any GI problems from the PI's worse. The Lexiva would be 2 pills in the morning and 2 in the evening. He did say that some doctors don't like the unboosted Lexiva but I stated his reasons for not prescibing it above. Thanks everyone for your input. It's just what I needed to wrap my head around all this. It's nice when a moment of clarity comes by, lol.

[HollyStar]

Well, I just picked up my new meds and will most likely be starting them in a few days. But holy crap are they pricey! I thought Atripla being $1,700 was bad but these new meds are around $2,800 total a month! These insurance companies must hate people like us!

[Inchlingblue]

Well, I just picked up my new meds and will most likely be starting them in a few days. But holy crap are they pricey! I thought Atripla being $1,700 was bad but these new meds are around $2,800 total a month! These insurance companies must hate people like us!

Wow and that's without the Norvir? Norvir is pretty pricey so it would have been way more.

Those insurance companies make huge profits and their executives are highly compensated. I imagine they'd like to kick out all those with chronic conditions so they can make even more profits.