Complera vs. Stribild for treatment naive

[NYC Anon Guy]

I've been poz for over 15 years and never needed meds. T-Cells were normally between 500 - 700.  My VL generally was around 10,000, although sometimes it would go up to 60,000 or even 200,000 during stressful times. Now my Tcells are 387 and VL is 18,000 and the doc wants me to consider going on meds. He suggested specifically Complera or Stribild. Does anyone have experience with both, and could you compare and contrast your experiences? Also, if anyone has a recommendation of which of these treatments I should choose, feel free to chime in with your opinion and reason.

[buginme2]

Here is how these threads play out.

Everyone on Complera will post how great it is and how it doesn't have any side effects and you should take Complera.

Everyone on Stribild will post how great it is and how it doesn't have any side effects and you should take Stribild.

They are both new medicines with little to no side effects.

You will do well in either.

Stribild may be "stronger" but it's also harder on your kidneys.

Complera shouldn't be used if your starting viral load is over 100,000

[maxmarco]

Hello. Sorry to bring up an old thread, but I haven't found a good thread of Complera vs Striblid anywhere in the forum or web, and I need to choose between the two. I am newly diagnosed, CD4 at 80 VL at 20k, and just got a prescription for Complera and another for Striblid. Doc is letting my chose. Will try to choose one within 48 hours and then start. I'm torn. I posted this as well, in less detail, on my personal thread in the "I just tested POZ" section.

So according to the med brochure Striblid has a higher percentage of side-effects and it should not be taken with more than 25mg of Viagra every 48 hours (think will really need it now that I'll have to use condoms). And based on what I read it is worse on the kidney. Complera on the other hand supposedly generates more gas problems, and more importantly can generate depression (in 1% of people).

Please know I suffered severe depression this year, but this year only, never before, and it was not physical/clinical, but rather entirely due to a career/financial shithole I put myself in, and then due to thinking I had infected my wife. In other words, both sources of depression were very real. Some forum members advised me to stay away from Complera because of this. Now the thing is I'm feeling very upbeat now. Feeling my usual self. Knowing my wife is fine gave me back all the energy and positive attitude I had lost.

So Striblid or Complera?

Would be great to hear from those how have tried both!

Side-effects quantified on the meds pamphlets:

Complera:
Nausea 1%
Hedache 2%
Diziness 1%
Depressive disorders 1%
Insomnia 2%
Abnormal dreams 1%
Rash 1%

Striblid:
Diarrhea: 12%
Flatulence: 2%
Nausea: 16%
Fatigue: 4%
Somnolence: 1%
Headache: 7%
Dizziness: 3%
Insomnia 3%
Abnormal dreams: 9%
Rash: 3%

Thanks!

[Reggie]

Hi I can't tell you about stribild but I can tell you I recently changed from atripla after 8 months with annoying side effects (depression, vivid dreams, brain fog) to complera and within days all side effects disappeared. For some having to take with 400 calories difficult but as like to eat works great after breakfast. All the best with whichever regime you go on, probably either will work well as from what I've researched and read from helpful members here on the forum.

Cheers

Reggie

[Irish Eyes]

I've been following your roller coaster of a 'journey' and though I can't give a comparison, I've only been on Stribild with absolutely zero side effects.

Another detail to take into consideration is calorie requirements.

My understanding is that Complera requires practically a meal, Stribild can be taken with mearly a snack.

[buginme2]

1.  Don't focus on the 1% that get gas or some other side effect.  Both of these are new medications and for all practical purposes, side effect free.

I take complera.  It's ok. Except for the meal requirement. If you don't have a set schedule the meal requirement can be a pain.  It does need a meal.  While that's not a huge deal it can be a deal.  It's more of real world problem then side effects.


Full disclosure..I'm getting off Complera because the meal requirement has become too much of an obstacle.

[maxmarco]

Thank you all sincerely for your comments!

So here's where I'm standing:

Striblid main cons for my present self:
- higher probability of nausea and headaches
- viagra counterindication

Complera main cons for my present self:
- slight chance of suffering depression

I'm mainly worried about side-effects that may affect my job search (eg, headaches, depression), and not so much about insomnia, gas and others at this point. So still torn 50/50 based on the above. The cost doesn't make a difference as both should be $0 for me.

Had not considered the meal requirement for Complera, which is important given how meds have to be taken ideally at the same time of the day but guess if I choose breakfast as the time and I have to ran to the office and forget to have the pill can always have a cream cheese bagel, those have 400 calories. 400 calories sound doable. Although on the other side if during the week I take it at 6-7am, that would mean having to take it at 6-7am on the weekends as well, right?

I just read that Complera "May be somewhat less potent" (here: hivforum.tumblr.com). That new sliver of info is now making me lean towards Striblid given my late diagnose / poor numbers.

Won't make a decision until tomorrow, so if any other member with experience on these drugs, particularly both, reads this and has time to reply, please, I would love to know your thoughts.

Thank you!

[buginme2]

1.  , you do not have to take your meds at the same time every day.  I don't think I've taken my meds at the same time once in the last several years.  It doesn't matter.  Just take it once per day.

2.  Complera is less effective if your viral load is over 100,000.  That's what they mean by less potent.  If you have a high viral load you shouldn't pick complera. 

3.  I doubt stribild will give you a headache. If it does it Will probably be for a few days and then go away. 

I think you are misunderstanding the whole side effect thing.  These are not long term side effects. Your not going to have side effects every day.  You may get them in the beginning but they go away otherwise they wouldn't get approved.

[maxmarco]

Thank you! Should I just flip a coin then?   

[buginme2]

Thank you! Should I just flip a coin then?   

Well you could.  If I were you I would take stribild and adjust your viagra dosage down. If your worried about the interaction or take a lot of other drugs then go with Complera..

[maxmarco]

Thanks buginme2. Think I'll be going with Stribild. Worry not, if whatever side-effects don't fade away after a month I won't blame you If that were to happen I'll simply wait till undetectable and then switch to Complera.

[Matts]

And what about Triumeq? Or is it not an option for You?

[maxmarco]

Damn, I forgot to research it as an option, and Doc didn't bring it up. Thanks. Presume  insurance would cover it, and a co-pay card should be available as well. Looks like a solid option. Seems to have less side-effects than Stribild, be gentler on the liver and kidney, and have no interactions with viagra or adderall. Just what I would like. On the other hand it requires a previous allergy test, to Abacavir, which I guess could take 5-10 days for the results. I would rather not delay starting for that long. I'll start on Stribild and keep an eye out for Triumeq.

I read on one of the posts someone saying Matts is particularly knowledgeable of HIV. Would that be you? Would you have any thoughts to share on Triumeq? Thanks!

[Matts]

I didnt want to post any medical anymore; as our dear user Buginme2 said correctly that we we all are only laymans and it is mostly BS. But if U ask me directly...

Atripla is not an option anymore- too many side effects of Sustiva.
Complera has the lousy food requirement.
Stribild has this additional Booster- not an option if U like Party drugs or Viagra. And the booster is an additional burden for liver and kidneys.

I like Triumeq for 6 months- no problems so far.
 But there ist still the discussion about the cardio-risk of Abacavir and U need a genetic test. But it is the only FDC without Truvada.
 I am not an expert, but i would make this HLA test and try Triumeq.
Please ask your Dr. and Google a bit. It is Your choice

[buginme2]

Yeah full disclosure I'm switching to triumeq in two weeks assuming my hla test is negative. 

Like matts said..we are just dudes on the internet, real advice should come from the doctor and your own research.

[tednlou2]

Stribild has this additional Booster- not an option if U like Party drugs or Viagra. And the booster is an additional burden for liver and kidneys.

The kidney and liver issue with Stribild is something I have been curious about.  A doc at The Body said he doesn't like drugs that inhibit normal liver function.  He did say there was "scant evidence" it is a problem.  Dr. Gallant said there is no issue in "inhibiting normal liver function."  It does leave many wondering.  Will the booster, Cobicicstat, in Stribild boost things like Tylenol, putting more stress on the liver?  Dr. Gallant says that's not an issue. 

As for the Tenofovir, Dr. Gallant said injury can be predicted and monitored.  If abacavir (Epzicom and in Triumeq) is shown to cause increased risk for heart attack, then that is something you really cannot screen.  I took that to mean you won't necessarily see jumps in lipids.  He said while some think the cardiac issue has been settled, he said it most certainly has not-- which is why it is not recommended for those with risk factors and who smoke.

[maxmarco]

On the recreational drugs incteractions, found this to be very good:
http://www.thebody.com/content/art14383.html

Covers alcohol, street drugs and some prescription drugs.

The only one of the three (Stribild, Complera, Triumeq) mentioned as interacting directly with alcohol is the later:

"Alcohol increases Ziagen (abacavir) levels in your blood. A small study showed that consuming the equivalent of five alcoholic drinks with Ziagen resulted in up to a 41% increase in Ziagen levels. The increase isn't a good thing. Regular Ziagen dosing (300 mg every 12 hours) gives you enough of the drug to do the job. Increasing the amount won't fight HIV any better -- but it could increase your risk of side effects. Ziagen is also in the combination pills Trizivir and Epzicom."

[Matts]

ok thx- the link is interesting.

Norvir has the same effects like Cobicistat. I had some  unpleasant experiences with Norvir - as posted in Your link.

I also dont like the Abacavir very much, I would better take TAF, but it is not available yet.

Not more than 5 alcoholic drinks with Triumeq from now on- it should be manageable.

[maxmarco]

Nothing new below, but though a summary could be useful for future visitors:

Stribild (http://aidsinfo.nih.gov/drugs/507/stribild/0/patient)
150 mg elvitegravir (integrase inhibitor)
   http://aidsinfo.nih.gov/drugs/421/elvitegravir/0/patient
150 mg cobicistat (booster)
   http://aidsmeds.com/articles/GS-9350_16065.shtml
300 mg tenofovir (nucleoside reverse transcriptase inhibitor - NRTI)
   http://aidsinfo.nih.gov/drugs/290/tenofovir-disoproxil-fumarate/0/patient   
200 mg emtricitabine (nucleoside reverse transcriptase inhibitor - NRTI)
   http://aidsinfo.nih.gov/drugs/208/emtricitabine/0/patient

Complera (http://aidsinfo.nih.gov/drugs/441/complera/0/patient)
25 mg rilpivirine (Non-nucleoside Reverse Transcriptase Inhibitors)
   http://aidsinfo.nih.gov/drugs/426/rilpivirine/0/professional
300 mg tenofovir
200 mg emtricitabine

Triumeq (http://aidsinfo.nih.gov/drugs/534/triumeq/0/patient)
50 mg dolutegravir (Integrase Inhibitors)
   http://aidsinfo.nih.gov/drugs/509/dolutegravir/0/patient
600 mg abacavir (nucleoside reverse transcriptase inhibitor - NRTI)
   http://aidsinfo.nih.gov/drugs/257/abacavir/0/patient
300 mg lamivudine (nucleoside reverse transcriptase inhibitor - NRTI)
   http://aidsinfo.nih.gov/drugs/126/lamivudine/0/patient

"Integrase inhibitors: block an HIV enzyme called integrase. An enzyme is a protein that starts or increases the speed of a chemical reaction. By blocking integrase, they prevent HIV from multiplying and can reduce the amount of HIV in the body."

"Booster: It increases the blood levels of elvitegravir. It does not directly work against HIV."

"NRTIs: work by blocking HIV reverse transcriptase, an HIV enzyme. This prevents HIV from replicating and lowers the amount of HIV in the blood."

[ChavinKnight]

I'm coming up on a full year on Stribild...so far so good.  I would never agree to Atripla, but I asked my doctor about Complera, and he said no go with potential stomach issues.  I could have worked around that, but the thing that troubled me is that IF you get resistance on Complera, it can produce cross resistance to a whole class of drugs.  I was leery of that....