POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: RobbyR on February 04, 2013, 05:43:49 pm
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I'm thinking of switching regimens to prezista/truvada/norvir wondering if anyone has ditched Atripla or as I like to call it these days "the insomnia pill" for a friendlier pi regimen? Would I have to take 2 prezistas plus the truvada and norvir? What is the recommendation for this regimen for patients who have already been on treatment? Maybe Ann or Miss P could shed some light, as I remember they recommended they took this regimen. I'm also thinking about Intelence/truvada. But as someone who has only been on an NNRTI, wondering if I should expect anything different from a PI regimen. I know I'd have to take more pills a day, but correct me if I'm wrong, that actually won't make a difference.
I took that Trazodone and dayum that stuff is effective you out like a light on it! So it helps, but I am actually hopeful that a PI regimen might be worth trying for me.
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I switched from Atripla to Prezista/norvir/isentress. I don't do the Truvada part of it, which is not normal for most folks, just something me and my doctor discussed. I have no issues with it at all. you can take either 2 400/mg Prezista or 1 800/mg prezista
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Hey Robby ,
I switched to prezista/truvada/norvir several months
ago . I am in heaven :)
I was on Reyetaz / norvir / truvada for several years and felt like crap , I spent
a few years in the bathroom :-[
Good luck with this regimen as it is friendly to the gut and I have found
few side effects ,I am not yellow anymore .
Still have belly issues about once a week , But oh GOD
everyday was killing me !
Be well ,
Weasel
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Hey , I take two prezista's , one truvada & a norvir ;)
and ............... Loperamide , two capsules !
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Sounds like you are doing great on prezista/norvir/truvada, weasel! Ann and Miss P also mentioned this combo as being very easily tolerated. And taking more pills wouldn't bother me, it doesn't mean it's more potent than the once a day regimens. I've done great on Atripla and hate to ditch it but the insomnia isn't worth it. I'd want to avoid Reyetaz tho. As far as Isentress, I'm sure it's better than Atripla, but it is known for insomnia also as Ann mentioned to me once. So I'm probably going to go with the prez/norvir/truvada when I change.
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I've been on this combo since June of 2010. I take all four pills at noon. No problems for me. The worst side effect I had was while taking Bactrim Monday, Wednesday and Friday to fight PCP at the beginning - I was living in the bathroom!
My ID has a pharmacist join him on rounds and the pharmacist said I could seperate the pills if I couldn't tolerate swallowing all four at once. Having a mind in the gutter I told him swallowing all four pills at once kept my throat loose. He was speechless.
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Robby, my partner was switched from Sustiva to Intelence due to insomnia issues and it hasn't made much difference. It's just my opinion, but I don't really see the point in switching to another NNRTI when Sustiva is giving a person problems.
It's true that most of the other NNRTIs don't have quite the side-effect profile that Sustiva does, but they can all cause similar problems. It seems to me that if a person is going to have problems with Sustiva, they're going to be prone to similar problems with other NNRTIs. (Please note this is only my opinion, formed from years of hearing other people's experiences. I can't link you to any studies.)
edited to add...
(I just remembered that you have already tried a switch to Complera and it made your insomnia issues even worse. One of the meds in Complera is rilpivirine (aka Edurant) which is also in the NNRTI class. See what I mean about switching to another NNRTI when having problems with Sustiva?)
But yeah, Prezista, Norvir and Truvada is an excellent combo. It's well tolerated by most and is only taken once a day. It will be either three or four pills all at once, depending on whether you get the 400mg or 800mg formulation of Prezista. I get the 400mg formulation (meaning I take four pills) and it's honestly not a problem.
You may experience a bit of diarrhea at first (thanks to the Norvir), but it will, more likely than not, resolve within a week or two. Mine did. Keep in mind that not everyone will experience this and very few people experience it as an on-going problem.
I've had great results with this combo. My VL went from being in the 30,000s to UD and CD4s in the 300/400s to 1050 in six months. I couldn't be happier. (Well, I could be happier, but that would mean having a multi-million win on the lottery.) ;D
It's a good choice for both treatment naive and experienced folks. Several of our LTS are on this combo after having taken other combos over the years.
The only caveat with Prezista is that it needs stomach acid in order to be fully absorbed. All you need to do is to have at least a light snack - a piece of toast or some fruit will suffice. I usually take mine sometime in the afternoon when I eat, but you can take it at whatever time of day is most convenient for you.
The stomach acid issue with Prezista also means that you shouldn't take antacids two hours either side of taking it. I would imagine that this would only be an issue if you take antacids frequently. I can't see the occasional one-off being a major problem.
Same thing with eating something. If eating is not possible once in a while, it's far better to take your meds anyway and not worry about the food. For me, the less I eat when I take my meds means more Truvada farts a few hours later. And yes, I have taken my Prezista on an empty stomach occasionally, but it hasn't affected my lab results. I just don't make a habit of it.
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If you have no PI mutations then you can use the "treatment naive" dosing of 800mg Prezista 1 x day (+ 100mg Norvir).
If you have resistance that reduce the effectiveness of Prezista then the dose is 600mg Prezista 2 x day (+100mg Novir each time).
There will be a single 800mg Prezista v soon, which means the 1 x day version could be 3 pills (1 Prezista, 1 Norvir, 1 Truvada).
- matt
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Thanks everyone! I am strongly leaning to trying this regimen it sounds very tolerable. Ann, I think you are right because when I tried Complera, I had worse insomnia issues with it and so I suspect maybe I have just a threshold tolerance for NNRTIs at this point perhaps. Back on Atripla now, but the insomnia continues. I'm thinking this sounds like the best alternative out there, and really there isn't any difference in a PI vs. a NNRTI anyway. For me it's about improving quality of life while staying undetectable.
Newt, I have never taken any PI before, so not sure what dose they'd start me on, but I'd be fine with any as long as they work. Any efforts underway now to possibly consolidate some of these PI regimens into one pill?
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Newt, I have never taken any PI before, so not sure what dose they'd start me on, but I'd be fine with any as long as they work. Any efforts underway now to possibly consolidate some of these PI regimens into one pill?
Your doctor should have - and most likely did - run a resistance profile on you before you started meds. Chances are that you do not have any resistance. The most common resistant strain to be infected with is Sustiva-resistant and you obviously don't have that.
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"Research has begun to explore combining the protease inhibitor Prezista (darunavir) with the experimental boosting drug called cobicistat into one pill. Prezista is currently a preferred drug for people going on HIV treatment for the first time...
Further development of Prezista + cobicistat will also continue towards its own full-regimen pill. If the drug manufacturers sign their development agreements, Prezista + cobicistat will be combined with Emtriva (emtricitabine) and an experimental pro-drug version of tenofovir called GS 7340."
http://www.projectinform.org/news/new-combination-pill-works/ (http://www.projectinform.org/news/new-combination-pill-works/)
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I'll just make sure and ask my doc if they did do a resistance profile on me for PIs. Otherwise my mind is pretty well made up about ditching Atripla like a bad date that was good at first but now it's just dragged on way too long lol.
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I'll just make sure and ask my doc if they did do a resistance profile on me for PIs. Otherwise my mind is pretty well made up about ditching Atripla like a bad date that was good at first but now it's just dragged on way too long lol.
Personally, I prefer a drug regimen that might require taking a handful of pills but lets me be less crazy. Sadly, I am on Isentress along with the combo you are considering, which causes insomnia. But at least I can go a whole day without thinking about suicide, which is something the Sustiva directly caused. It's easy to think that our meds are benign, until they prove otherwise.
Please let everyone know how it goes!
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I'm of the old school mindset of don't blow through too many combos because I still remember how hard it was to find one that didn't make you sick 24/7 .
That mindset is changing rapidly for me and I'm thinking its time for me to try and ditch the Atripla myself . I woke at 3 am this morning and couldn't go back to sleep and the Atripla and trazodone I took was still raging and I really felt like I was tripping out . I useally sleep thorough this side effect but not this morning , I had to be at the hospital to greet new patients at 8 am and was in sad shape by then .
I think I have downplayed how Atripla effects my memory and cognitive function out of fear of making a change and being on it so long I don't know the difference any more . I see my doc on the 15Th and I'm going to suggest a change .
I still feel that changing your HIV regimens should be done after much sober thought and you should listen to what the doctor has to say about it and give it proper weight when considering a change . With all my experience living with HIV the decision to begin or change meds is a decision that still worries me the most , maybe it shouldn't but that's how I feel .
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jg1962, it sounds like you're in a very similar boat to me! Like you, I don't want to blow through many combos either. What I've noticed with the Atripla is for me it worked incredible for 2 years but about a year in I would started having occasional sleep problems. Then, slowly, they increased. And sometimes I would feel dizzy and really moody. But lately the falling asleep problem got pretty bad, I'd lay in bed for like 2 hours before I could fall asleep, then I'd want to sleep the next morning because I was missing my sleep at night. It really fucks with you. So I got some Trazodone and tried it a few times and it has REALLY helped me to fall asleep better!
Now, sometimes I still have good nights where I can get decent sleep, and then I wonder if maybe I should tough the Atripla out, but then I just have a stretch of bad nights again. Seems to be the prevailing pattern. I have also noticed my already short attention span has worsened since being on it and I am a bit worried of the other cognitive effects aside from the sleep problems (which I never had before starting it).
So it's like a jump into the unknown for me because Atripla is the first and only HIV med I have ever been on (with the brief exception of Complera) but after hearing the great reviews and recommendations by Ann and Miss P and others, I am going to suggest to my doc that I try Prezista/Norvir/Truvada. I will of course keep using my Trazodone if needed, but like the pros on here have told me, modern PI's are fine and well tolerated. Ann told me that if I'm having problems with one NNRTI, I'll probably have problems with others, so a PI might be a safer bet for me. What regimen are you thinking of asking for?
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What regimen are you thinking of asking for?
I'm not sure yet . I tried Isentress and Prezista , one of them didn't work and the other I couldn't tolerate the Norvir and my viral load wasn't responding as it should on either one . I was 100 % compliant and took them as directed .
I was tested for resistance issues and there were none and I forgot the theory's my doctor offered as to why the new meds didn't work .
I will post an update once I see my doc and she refreshes my memory about the old meds and what we decide to go with for the change .
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I know what you mean. A friend of mine tried Isentress/Truvada but had to get off it because it gave him bad insomnia. No regimen is perfect..Maybe you could try Stribild or Intelence/Truvada, or another one. There are so many combos it makes one's head spin lol. I guess the trick is doing one's homework, deciding on one that seems like a good fit for our particular needs, thus not having to go through a bunch of different combos. I agree,changing HIV regimens is not an easy decision! It's sort of like you might be trading the devil you know for the one you don't. However, bad side effects like we seem to be having with Atripla can become intolerable. If I change, I'm going to go with Prez/Norvir/Truv, or Intelence/Truvada, I need more info about Stribild before I'd be willing to go that route..Let us know what you decide on. I'll do same.
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Ann told me that if I'm having problems with one NNRTI, I'll probably have problems with others
I'd just like to clarify again that it's only my opinion that a person who has trouble with one NNRTI might be more prone to problems with other NNRTIs.
True, it's an opinion formed after years of noticing it happening to others (in other words, anecdotal evidence, not any studies), but I've also know quite a few who switched from a Sustiva based combo to a Viramune based combo with no problems. Viramune is also an NNRTI.
So is the Intelence you're considering (an NNRTI). That's what my partner was switched to due to sleep problems on Sustiva and it hasn't made much difference. His main problem is getting back to sleep after getting up in the middle of the night for a wee. As an over 50, that happens most nights. (Oh the joys of getting old!)
And just a little Sustiva aside that you might be interested in hearing - when my partner was first put on Sustiva (and Combivir* as was usual back in the early 2000s), he had really bad nightmares every freaking night. I mean waking-up-the-whole-house-and-neighbours-too screaming nightmares.
He'd been an aide worker in South Sudan during the 90s and every night he relived every horrible thing and all the human suffering he saw there - but even more gruesome and horrifying than in real life.
Back in those days (early 2000s), Sustiva was considered the freakin' bee's knees. Instead of switching him for something else (fewer choices available then), they did something called Therapeutic Drug Monitoring (TDM) on him and discovered that he always had much, much higher concentrations of Sustiva in his blood than he should have had.
The usual dose is 600mgs. At first they dropped him down to 400mgs, but he was still having nightmares more often than not and TDM still showed too-high levels. Then they dropped him down to 200mgs (practically unheard of!) and the nightmares stopped for the most part.
He remained UD on this low dose for around nine/ten years (aside from the occasional blip), until they switched him to Intelence late last summer. (still UD) While he no longer has the nightmares, and no longer talks in his sleep, he's still having trouble getting a good night's sleep.
*They switched the Combivir out for Truvada ... around 2007, IIRC.