POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: secreto on November 24, 2006, 03:32:02 pm
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Aloha, I was just wondering if anybody might be on or have any insite on this drug combination.
I will be starting this combo soon & am very worried and stressed out.3 PI's i don't know if i will be able to handle it.My doctor told me that this would be good,but am questioning his advise.
My t-Cells are very low around 28 but my viral load is 12000.Does anyone have any advise? Aloha & Thank You
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Hello, welcome
Why are you starting on the Lexiva and the Prezista together ... ?
If the issue is PI resistance then Prezista may well be good enough on its own. Studies show good results, undetectable in many cases, for people with PI resistance using this drug. I therefore share you concern about all these PIs and whether they are necessary.
However, both PIs may be necessary if you can't use NNRTIs (Sustiva etc) and a resistance test suggests Lex / Prez is the right combo to beat a mutant virus mix.
If you have no PI resistance of any kind then only one of Lexiva or Prezista is needed (or indeed one of several other PIs too).
The Norvir don't really count, its a low dose to make the other PIs more effective.
Questioning yr doc's advice...I hope so...it's your body after all.
- matt
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Hello, welcome
Why are you starting on the Lexiva and the Prezista together ... ?
If the issue is PI resistance then Prezista may well be good enough on its own. Studies show good results, undetectable in many cases, for people with PI resistance using this drug. I therefore share you concern about all these PIs and whether they are necessary.
However, both PIs may be necessary if you can't use NNRTIs (Sustiva etc) and a resistance test suggests Lex / Prez is the right combo to beat a mutant virus mix.
If you have no PI resistance of any kind then only one of Lexiva or Prezista is needed (or indeed one of several other PIs too).
The Norvir don't really count, its a low dose to make the other PIs more effective.
Questioning yr doc's advice...I hope so...it's your body after all.
- matt
Thank you Matt,
I do have a resistance to NNRTIs except for Rescriptor.I have been positive for 12yrs and also do have a resistance to a couple of the PIs.Living here in Honolulu is a great experiance,the only thing is we don't have many Hiv-Specialist here.I really appreciate your e-mail matt,,Mahalo,,,,,,Craig
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Regarding combining Prezista with other PIs: There are currently NO data with respect to combining Prezista and Lexiva. There are some pharmacokinetic data with combining Prezista with Reyataz; they do not seem to affect each others' drug levels (when boosted with Norvir 100 mg twice a day). There are negative pharmacokinetic data with combining Prezista with Kaletra and Invirase: Prezista levels are decreased by Kaletra and Invirase and so those combinations are not recommended.
Have you considered using Fuzeon with the Prezista?
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Thank You Gerry for your insite.You would think after all this time beiing hiv+ i would be use to being a pin cushion of sorts.The doctor did mention Fuzeon but my fear of needles halted that idea,at least for know. Mahalo for your reply! I really appreciate any and all insite.
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Gd point Gerry on the interactions non-info...
Craig, I am interested to know which PIs you are resistant to / have taken before. If you can get your hands on the actual resistance test info this is most helpful.
- matt
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Aloha Matt,
I do have my PhenoSense Resistance Assay.The PIs im resistant to are Viracept wich i was just on for 8 yrs.Im also resistant to Crixivan and also the Norvir.Although im not maxed out on the Norvir.,Mahalo,\Craig
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Have you considered using Fuzeon with the Prezista?
Or take out the one other PI and just do the Fuzeon with the Prezista/Norvir/Truvada.
THAT is the combo I've been on now for six months and I've had fairly spectacular results. My first EVER non-detectable VL (been on HAART for 13 years) and my cd4's have increased by about 60% and all of this has been stable.
Secreto: I've been doing the fuzeon with the new biojector device -- no needles involved. See if your doctor can offer you this option.
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If these are the only two PIs that are unworkable, you have a choice of other PIs, of greater or lesser likelihood of effectiveness, but tis a choice.
At a guess I would say Prezista is likely to do you proud. It really depends on the mutations your resistance test records. So a guess... It has had very good results in trials, even for people with extensive PI resistance (worse than yours probably is).
The choice of PI should be based on the resistance test info. Ideally you want an up-to-date resistance test. Assuming you have one, and are saying this shows Crix and Viracept are the only two PIs that won't work, then the choice is kinda wide.
Me, being a belt and braces kinda guy would go for the strongest . . . Norvir resistance unimportant since you's only gonna use this as a booster drug.
But, you will probably still only need 1 boosted PI. (okay, probably, I ain't saying for certain)
On the Phenosense report there will be a list of drugs with SENSITIVE, REDUCED etc. The most effective drugs will be the ones with the (hopefully blue for sensitive) bar furthest from the line n arrows that marks the cut-off point for them to work (see pic).
- matt
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yeah, I should have added I'd developed resistance to basically all the PI's before going on Prezista
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I can't thank you guys enough, matt & philly267.You both have given me good imformation.Boy its times like this i really wish i lived back in San Francisco w/more doctors & specialist,but thank goodness for this forum so i don't feel so alone & confused. :)
I will start my new meds on this comming monday,a little nervous but will try & keep it positive.Wishing you guys the best & once again ,Mahalo for your insite. Craig
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Hello Craig. One year ago my previous regimen of Reyataz, Norvir, Viread, and Emtriva failed miserably. After nine years above 200 on meds, my CD4's dropped like a rock from the 300's down to about 100.
Luckily, I had skipped Kaletra and started it with Invirase, Fuzeon, and Combivir. Now I am undetectable under 50 for the first time in my life, CD4's are back above 300.
However, I know that I would not be where I am today without the Fuzeon. It is hard to initially accept the shots every 12 hours. I just got back from a trip with my partner and believe me it is a royal pain to travel with. But, it is also nice to have a little peace and pause in the progression of my HIV which has been around for 21 years.
My two cents: If I had 28 CD4's, I would DEFINITELY commit to Fuzeon with the Prezista. (i have a friend that has had good luck with the combination) You will likely waste the Prezista without using Fuzeon. I would also try to get on either the Merck or GS integrase inhibitor. I think if you were to do all three of these, you might see a remarkable turnaround.
Otherwise, I think you will find that life can be more difficult to manage with CD4's hovering below 50.
Best wishes,
--JJ
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Wow , im happy your doing so well JJ.Thank you 4 all the good infomation.Its such a crap shoot with these meds,but im finding out that i shouldn't be so afraid of the Fuzeon.Mahalo JJ,i appreciate your sharing your thoughts & personal story.Wishing u the best to.
Aloha Craig
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Craig, please don't take Lexiva and Prezista together, no-one knows how they interact
A second opinion may be in order on the resistance info before you decide.
The Merck integrase inhibitor has an expanded access programme now (see here (http://www.aidsmeds.com/drugs/MK-0518.htm)) [edited the link doh! ta jj].
- matt
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Craig, I think Matt meant here for the Merck Integrase 0518: http://www.aidsmeds.com/drugs/MK-0518.htm (http://www.aidsmeds.com/drugs/MK-0518.htm)
I agree with Matt. Do not start anything new without making sure it is the absolute strongest combination you can obtain. Personally, with my doctor in agreement it would be Prezista, Fuzeon, Merck 0518 Expanded Access, and then the best nuke combo based on resistance profile.
If you start Fuzeon, do not miss any injections.
--JJ
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Matt & JJ, You guys are so right,i wanted to get a second opinion,the only problem here is theres only 3 Hiv-Docs here & no one is taken new patients.Although we do have The Aids Clinical Trials at Leahei Hospital,i will try monday to get in touch with them for recomendations on my labs & Pheno Tests.
Thank you so much for your concern & Knowledge it means an awful lot. :) Mahalo, Craig
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Craig:
You could still go back to your doc and reconsider Fuzeon/Prezista/Truvada, which is a reasonable combo to expect good results from considering the resistance that you mentioned, rather than using Prezista/Lexiva, which lacks data on potential interactions. It seems like the only other PI so far (in addition to the Norvir boost) that can be added to Prezista is Reyataz, and even that combo does not have clinical data. However, at least it's known that the combination probably will not negatively impact each drug.
Gerry