Torn

[sir2545]

Hi guys,

Since the last time I was in the forums, I have had two test results with my numbers being 372/1800 the first time and just in from the doc this morning where my numbers are 470/5500.  The doc suggested that it would be a good idea to start taking Atripla.  I told him that I had expected he might say that and agreed to try and start it within the next two weeks.  After more consideration though I thought it might be good measure to get one more set of numbers before making a final decision about starting the meds. 

I am looking for advice on this, and need to know what considerations (long and short-term) need to be made before starting meds.  I am also wondering if I might start the meds taking them every other day instead of everyday.  I'm sure the doctors probably dont recommend this, but I dont see how it could hurt.  Its just an extended frame of time, and I dont understand how your body would really know the difference.  Then sometime down the road, increasing the dosage to everyday.  I just somehow think that the docs are giving advice to benefit themselves instead of the patients, and might I add the ID doctor's office has its own pharmacy.  I cant be sure he is instructing me to start meds because he thinks it would be beneficial, or if he is merely taking advantage of the fact that I'm naive.  I don't care about taking the medicine because it will give me a lot more piece of mind, I'm just a big ball of confusion right now and could use some guidance from all you guys.  Im still trying to learn as much as I can about all this and you guys have made this a lot easier to deal with.  Thanks in advance

[Inchlingblue]

.  I am also wondering if I might start the meds taking them every other day instead of everyday.  I'm sure the doctors probably dont recommend this, but I dont see how it could hurt.  Its just an extended frame of time, and I dont understand how your body would really know the difference.  Then sometime down the road, increasing the dosage to everyday.  

If anything it should be the other way around: I would make sure to take Atripla every day, as directed, until you become undetectable and stay undetectable for at least six months and then you can consider a more unorthodox approach (but not the one you're considering of every other day).

The only alternate Atripla dosing that is acceptable, based on a study that showed it could work with some people is "Five Days On, Two Days Off" (FOTO study), link below.

You should thoroughly learn about drug pharmacokinetics and resistance and how HIV mutates before even considering trying things that are unconventional.

LINK:

http://www.hivandhepatitis.com/2009icr/ias/docs/080709_a.html


EDITED TO ADD:

The reason for every day dosing is that there must be a minimum level of drugs in your body in order to control HIV. It's very tricky to play around with this since there's no way for you to know what your drug levels are at any given time, without measuring them through a special test.

[Hellraiser]

Let me be the first to suggest against taking the pill every other day.  The number one rule of HIV meds is adherence.  You want to be as close to the 100% marker as you possibly can be.  Taking the medicine every other day is not what the company advises, not what the doctor advises, and is at best 50% adherence.  Every other day also creates the problem of "Ok did I take the medicine yesterday? or the day before?" and you can't even go by day of the week because it would change every week.

Lately it seems like everything seems to be starting treatment early and in my opinion I don't think I would wait.  Atripla in particular really isn't bad at all.  Although like others have suggested you may want to fill your first prescription and build a stockpile before beginning the regimen.

With your numbers you could wait for another set of numbers and it most likely wouldn't be a problem.

So in short term considerations...just make sure you're not doing anything particularly important the first two days you take the meds as they have a dizzying effect at first (which subsides pretty quickly).

Long term considerations...make sure you can remain adherent once you begin as once you start you could potentially develop resistances to the medicine if you miss doses.  

[Assurbanipal]

Ramping the drugs up slowly is an interesting idea, and it may work when you are taking drugs that are intended to get your body to do something.  Ramping up can allow your body to acclimate to the drug. So some drugs (especially ones that are targeted at improving a body or brain function) do work best  with a ramp up.

But Atripla and other HIV drugs don't work that way.  Instead of helping your body do something they are instead aimed at stopping the virus from doing anything.  Ramping up the HIV drugs slowly might give the virus a chance to acclimate to the drugs and keep working.  So ramping up slowly is a bad idea for HIV drugs.  That's why you need to take them consistently, more consistently than almost any other drug.  


As far as whether your doctor is giving you bad advice because he owns a pharmacy...
1) Even though he may have a conflict, his advice is consistent with the current US treatment guidelines.  They say you should start if you have less than 500 tcells
2) But if you don't trust him, maybe you should get another doc.

Best wishes

A

[Ann]

I am also wondering if I might start the meds taking them every other day instead of everyday.  I'm sure the doctors probably dont recommend this, but I dont see how it could hurt. 

Look mate, if you're not ready to take the meds as they are prescribed, DON'T TAKE THEM.

Going by your numbers, you don't need them now anyway. You've got a low viral load and a medium CD4. My numbers are similar and I've been poz for nearly 13 years, still not on meds. And I'm doing well. There's all sorts of talk recently about starting sooner, but it's not done me any harm waiting. If you cannot commit to taking the meds properly, you'd be better off waiting too.

If you don't take these meds properly, and I mean every day, then don't bother. You'll do yourself more harm than good. If you cannot commit to taking them every day, at regular intervals, then wait until such time as you ARE willing to commit. To do otherwise is just plain foolish.

Fucking around with your dosing schedule is just asking for resistance. Do you really want that?

Ann

[sdguyloveslife]

I am also wondering if I might start the meds taking them every other day instead of everyday.  I'm sure the doctors probably dont recommend this, but I dont see how it could hurt.  Its just an extended frame of time, and I dont understand how your body would really know the difference. 

Any medication that you put into your body has a "half-life."  The half-life is the time it takes for your body to metabolize and eliminate half of the quantity of medication.  In medicine, we have what is called a "therapeutic dose" which means that in order for the medication to have any intended effect at all, a specified level of the drug must be present in your bloodstream, otherwise you might as well be taking nothing at all.  In order to be effective, the levels of HIV drugs in your system must consistently be at or above the therapeutic dose. 

An alternative and much simpler explanation of what you are suggesting is like buying a flashlight that requires 2 batteries and then expecting it to work anyway when you just put only one battery into it. 

Moreover, as if that's not bad enough - there is a greater danger of developing resistance that Ann mentioned already. 

I agree with Ann, if you can't take the drugs as prescribed, save yourself the side effects, money, chance of resistance, etc, etc...and don't bother with them. 

[mecch]

Click on ALL ABOUT HIV and TREATMENT in the menu above.
Or even just go to wikipedia and read about HAART.
If you really want to learn about HIV and its treatment, it seems like a good idea because you have correctly identified yourself as naive. 
If you have conversations with the same amount of ignorance with your doctor, and he/she doesn't instruct you clearly about how the treatment works, change your doctor.
If it is you just being too lazy or fearful or ambivalent to learn it yourself, then please don't start treatment until you do learn something.