Alternating Days - Biktarvy Med - Not Taking Meds Every Day

[jcelvis]

Just got off the phone with my Dr, about the side effects of Biktarvy (weight gain/fat distribution in the lower abdomen region) . I've been undetectable for 10 years now.

My Dr says the Biktarvy drug is so powerful, that it's safe for me to not take the drug everyday. He says I can start taking the drug 1 day on/ 1 day off (alternating days, such as taking it every odd day).

Is anyone doing this?

I have been adherent for 10 years, but the weight gain in the stomach area is causing me undo stress.

[Grasshopper]

Sounds odd

https://www.biktarvy.com/taking-biktarvy

What should I do if I run out of medicine?
When your BIKTARVY supply starts to run low, get more from your healthcare provider or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped even for a short time. The virus may develop resistance to BIKTARVY and become harder to treat./b]

[leatherman]

the side effects of Biktarvy (weight gain/fat distribution in the lower abdomen region) . I've been undetectable for 10 years now.

halfway taking an antiretroviral is a terrible way to compensate for side effects.

so some questions to consider:
how long have you been taking Biktarvy?
when did you start having this side effect?
Why did you change to this regimen?
Was your previous regimen working for you?
what other regimen has your doctor suggested that might not have this side effect?

[Jim Allen]

Guinea pig, interesting.

I don't know of any real world studies to back up the doctors claims on Biktarvy. Last and most recent attempt with modern ART and non daily treatment came with mixed results and a heatlh warning.

Anyhow, best of luck whatever you decide to do.

i-Base report urges caution over French study only taking ART 4 days a week
@IAS_conference  see: link: http://i-base.info/htb/36517

[J.R.E.]

My Dr says the Biktarvy drug is so powerful, that it's safe for me to not take the drug everyday. He says I can start taking the drug 1 day on/ 1 day off (alternating days, such as taking it every odd day).

Is anyone doing this?

Short answer--Not me

I think your Doctor is wrong in suggesting this to you. We all know what the insert says: "One pill per day,  with or without food". 

It doesn't say anything about every other day.

Now ,  I can understand what you are saying about the weight gain. I had exactly the same issues, with Biktarvy, when I was on it.  And the weight gain came on quickly over a short period of time.

I switched back to Viramune and Epzicom on January 20th, 20. So its been about 2 months and 10 days or so.  I have dropped 6 pounds all in the mid section, since dropping Biktarvy. I feel a hell of a lot better about myself with the weight loss.  And I'm sure it's healthier all the way around.


Ray

[Matths]

Hi there, I can only second what the others here said: there are no data supporting an approach to take ART only every other day in order to prevent side effects including weight gain. In fact, you state you have good adherence and I assume this results in being undetectable for an extended period of time. I personally would never risk this accomplishment. Instead, I would do a careful analysis of treatment history and select a treatment that keeps the U status and doesn’t increase the risk for metabolic changes including weight gain. And there are dietary and life style changes that you could consider before risking to set you up for going through treatment failure. I would revisit this topic with your doctor. Good luck! Matt

[jcelvis]

Guinea pig, interesting.

I don't know of any real world studies to back up the doctors claims on Biktarvy. Last and most recent attempt with modern ART and non daily treatment came with mixed results and a heatlh warning.

Anyhow, best of luck whatever you decide to do.

i-Base report urges caution over French study only taking ART 4 days a week
@IAS_conference  see: link: http://i-base.info/htb/36517

There are studies: https://www.poz.com/article/atripla-taken-every-day-still-suppresses-hiv-high-rate

Alternate-day therapy is different than intermittent therapy and my dr explicitly expressed not skipping 2 days in a row, which is what they study your referring to does (4 days on 3 days off).

[jcelvis]

Hi there, I can only second what the others here said: there are no data supporting an approach to take ART only every other day in order to prevent side effects including weight gain. In fact, you state you have good adherence and I assume this results in being undetectable for an extended period of time. I personally would never risk this accomplishment. Instead, I would do a careful analysis of treatment history and select a treatment that keeps the U status and doesn’t increase the risk for metabolic changes including weight gain. And there are dietary and life style changes that you could consider before risking to set you up for going through treatment failure. I would revisit this topic with your doctor. Good luck! Matt

You assume that I haven’t done any dietary and lifestyle changes. This issue has been going on for 3 years, it’s related to the new drug class TAF. I’ve been complaining about weight since this drug class was released and finally studies are confirming my observations:

https://www.sfaf.org/collections/beta/what-we-know-about-descovys-impact-on-weight-cholesterol/

It’s not a minor issue for me. Its wrecking my metabolism and cholesterol.

[leatherman]

There are studies

atripla is not biktarvy

You assume that I haven’t done any dietary and lifestyle changes. This issue has been going on for 3 years,

why did you not return to your previous regimen or try a different regimen for the last 3 yrs?

You should have a discussion with your doctor about your side effects, and demand another regimen rather that suffer with this problem

[Matths]

Obviously you tried a range of measures but as you have noted you are experiencing what science seems to confirm now. I would recommend you go back to your doctor and discuss alternatives. And also read the literature with focus on switch studies in chronically suppressed patients, ie the TANGO study or others. But in any case you should create a timeline of all treatments you had in the past and list how you responded including side effects. Hope you can figure this out quickly! Matt

[jcelvis]

atripla is not biktarvy
why did you not return to your previous regimen or try a different regimen for the last 3 yrs?

You should have a discussion with your doctor about your side effects, and demand another regimen rather that suffer with this problem

I’ve been on 4 meds Atripla, Stribild, genvoya, biktarvy

Atripla and stribild are no longer accepts therapies by drug companies.

[Jim Allen]

There are studies: https://www.poz.com/article/atripla-taken-every-day-still-suppresses-hiv-high-rate

Alternate-day therapy is different than intermittent therapy and my dr explicitly expressed not skipping 2 days in a row, which is what they study your referring to does (4 days on 3 days off).

197 small sample size over 48 weeks with Atripla does not make Biktarvy last time I checked 

Atripla is well known in small studies but it's not a first line (modern) treatment anymore. What your doctor is suggesting has not been studied in large human trials with modern (first-line) treatment as far as I know, only 4/7 days with mixed results, hence I said Guinea pig,

Weight gain is a known issue although there are multiple factors to it, I would suggest discussing it more with your doctor, cut out the binge dieting as you put it recently and prehaps re-discuss/review other treatment options instead of experimenting with dosages.

Whatever you decide, I wish you all the best and hope you find a resolution that works safely for you.

Guinea pig, interesting.

I don't know of any real world studies to back up the doctors claims on Biktarvy. Last and most recent attempt with modern ART and non daily treatment came with mixed results and a heatlh warning.

Anyhow, best of luck whatever you decide to do.

i-Base report urges caution over French study only taking ART 4 days a week
@IAS_conference  see: link: http://i-base.info/htb/36517

[jcelvis]

Realizing why I quit this community a long time ago.

Jim- interesting that you’ll cherry-pick the articles to try to prove your point and on the other hand try to discredit mine.

 I don’t need a lecture on studies. Are you a doctor?

I’ve been going to my dr since I was diagnosed. I’ve had multiple discussions with dr, I’m not new to this.

I asked who’s trying this, not should I do this.

[Jim Allen]

Look, knock yourself out, no lecture intended.

I was just pointing out to be careful, consider alternatives and re-discuss, like most of the people who kindly took their time to reply to you. I don't need an article to point out Atripla is not Biktarvy.

What your doctor is suggesting is unstudied in current first-line treatments.
I would point out the same again for anyone posting about an unproven treatment regime here.

Jim

[leatherman]

What your doctor is suggesting is unstudied in current first-line treatments.
I would point out the same again for anyone posting about an unproven treatment regime here.

especially when there are other regimens that might not have the kind of side effect related here.

During the early years (90s-00s) I changed regimens a lot because side effects and then because of the huge improvement in treatment. Even though I have used 27 different meds through the last 28 years of treatment, I've been on my current treatment for nearly 6 years now, and before that I was on my last regimen for 10 yrs.

as someone who has switched meds, I would make a few more points for the OP and others to consider:

1. you don't always have to take a single pill regimen. there are plenty of two and three pill regimens

2.  you don't always need to change a regimen. Stopping side effects, saving money, reducing pill burden, moving to a more effective treatment are all good reasons. But if those issues aren't an issue, there may not be a reason to change.  While Atripla is not a first-line treatment, plenty of people have stayed on it for years. With my work in the Ryan White program, I know lots of people who still take Atripla - because it works for them. (personally I had horrible issues with Sustiva like a percentage of people did but if it works for these other people, good for them)

Is your regimen working for you (ie no side effects or manageable mild side effects, and remaining undetectable)? Sometimes not fixing something that isn't broken is the best option (and doesn't risk dealing with side effects the new med might cause ).

[jcelvis]

We’re in 2020. Quite a bit of advancements are occurring for people with suppressed viral loads

A couple of years ago no one was discussing two-drug regimes either.

 As much as you want to argue with me about this, there’s also no longitudinal studies on the how the constant level of elevated drug levels in the system is damaging our bodies. Toxicity is a concern for doctors and studies on regime simplification are happening and that includes methods such as alternate-day dosing.

You can be as conservative as you want in your approach to your medical treatment, stop treating me as I am unknowledgeable or that my doctor is incompetent because you don’t agree with his strategy.

I’m looking for people who are trying this method and you’re hijacking this thread with your holier than thou, my method is better than your method, attitude. 

[zach]

Edited... it wasn't nice

[Grasshopper]

Realizing why I quit this community a long time ago.

[leatherman]

my method is better than your method

LOL
it's not my "method", it's just the CDC/FDA approved dosage, but whatevs

[bocker3]

I'm not sure why folks are digging their feet in here.  The OP has made his stance clear -- a number of folks have (rightly) expressed their thoughts and provided some facts on his question.

Piling on like you are doing and going tit for tat with him isn't going to change his mind.  He trusts his doctor and is clearly planning to go forward.  So, if you don't agree, you gave your advice, now let it go.  Why push him away - it makes no sense.

To the OP -- you can't ask a question like yours and NOT expect pushback.  While, I feel, some have gone a bit too far and have delved into condescension, it was important to point out that this approach is unorthodox.  We certainly don't want newbies to think it's OK to do everyother day on their own.

It sounds like you are going forward with eyes wide open and with a doctor's blessing, so I wish you good luck.

Mike

[Jim Allen]

@All

A small ask, if you're not posting in the thread to discuss the topic with the OP then please just let it be at this point. No point in continuing.


@OP
Nobody has denied that progress has been made, nobody has said your doctor is incompetent either or mentioned anything against the general idea of reduced drug levels and regime simplification. Bi/mono therapy conversations are nearly as old as me.

You posted something, so expect comments and if you react, then expect a response. It's a forum and not everyone will see eye to eye with you, neither do you have to agree with people, nobody until your last post was arguing beyond reasonable discussion giving the topic or attacking you, so no need for the drama.

People have expressed slightly different points of view, or experience than you, and/or genuine concerns regarding what you are suggesting, it's not surprising.

To keep this in good order, if you have issues with peoples posts and don't wish to discuss it reasonably then here are your limited choices:.

One, you can use the Report to Moderator link found at the bottom of any post.

Two, you can put that forum member on Ignore by using the link that appears at the bottom of the user information next to their post. You can unignore a member by going into your profile and taking them off the ignore list.

Three, and my favourite, simply ignore it.

Jim 

[JosephP]

Just got off the phone with my Dr, about the side effects of Biktarvy (weight gain/fat distribution in the lower abdomen region) . I've been undetectable for 10 years now.

My Dr says the Biktarvy drug is so powerful, that it's safe for me to not take the drug everyday. He says I can start taking the drug 1 day on/ 1 day off (alternating days, such as taking it every odd day).

Is anyone doing this?

I have been adherent for 10 years, but the weight gain in the stomach area is causing me undo stress.

As explained by my ID, one the meds in Biktarvy (and I don't recall which) has a median life of 36hours or so. BUT not the others which have a considerably less half life. According to my ID, the imbalance of having one drug still active while the others have decayed can prove to be troublesome as these components need to act together. I asked if I could go the same, one day on one day off...  Stay your course!