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Author Topic: Dr wants to switch me from Atripla, I am not so eager  (Read 6682 times)

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Offline BlueandGold

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Dr wants to switch me from Atripla, I am not so eager
« on: January 18, 2017, 02:26:11 pm »
Atripla has been my only ART since I started my journey with meds in Feb 2010.  I have been undetectable since, no issues, my CD4 count quite nice (maybe low 600's). Today my doctor told me he wishes to discuss "medication options" at my next visit. Previously they tried to switch me to Complera but I pushed back on the grounds I felt Atripla was doing its job well and I have learned to live with it.

Question:  Has anyone else had their clinician try to switch them away from Atripla for no apparent reason? What to? What were the reasons given? This is at the VA Medical Center in San Diego. Thanks.

Offline bocker3

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #1 on: January 18, 2017, 04:15:10 pm »
What does "learned to live with it" mean??  If you are experiencing side effects, you might want to listen, with an open mind, to your doctor's reasoning.  That would probably be more germane to you than anything I or anyone on these forums could say, as he/she knows your actual situation and we don't.  One of the main reasons that people switch is the potential mental health issues than can occur with Sustiva.

I have been taking Atripla since 2005 (actually, started with Sustiva and Truvada, as Atripla hadn't come out yet, but same ingredients) and have not had any issues, so I'm not saying this to you because of any bad feelings toward your regimen.
I do plan to talk to my doctor in 2 weeks about switching to the new version of Tenofovir -- at which point I am sure we will discuss my entire set of meds.  I'll listen and consider. 

Personally, I think it is always a good idea to discuss options - to ensure that one doesn't remain on something simply "out of habit".

Mike

Offline Mightysure

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #2 on: January 18, 2017, 08:56:34 pm »
There's information through clinical research coming in that the Sustiva component could cause some neurological effects and potentially long term.  These drugs haven't been out long enough to know what any long term effects are.  But, at least in the US, Atripla isn't a first line treatment option, only second line if a patient has resistance to any of the first line regimens.
But ultimately the choice is YOURS. It's your body and it's your choice whether to switch or not. 

Offline pittman

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #3 on: January 18, 2017, 09:16:03 pm »
A couple months ago I switched from Atripla to Triumeq. 

I *felt* no side effects from the Atripla, my numbers were all good, and only a slight bump in my blood work that indicated my kidneys were working to process the medicine.

The reasons for the change were the potential side effects that Atripla could eventually bring over time in bone density and in kidney function. 

I was slightly anxious about the change as I was experiencing no side effects with respect to how I felt, my sleep/dreams, etc.  In the end, the change was a non-event, I have no food timing issues like I did with Atripla, and the only thing I have to do different is avoid the antiacides and certain supliments with calcium or iron within a certain window around the time I take the Triumeq.

I would encourage you to be open to talking to your doctor, and not just go with the side effects that you can feel as others can have some impact as well over time.

Offline harleymc

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #4 on: January 18, 2017, 09:38:55 pm »
Blue and Gold you ask a whole heap of questions about other patients and their doctors. Why is any of that relevant to you and your doctor?

Visit with an open mind be prepared to ask questions. You don't have to change that day. Maybe you should have asked some questions last appointment like,why? what to?

Instead of stressing and getting anxious, take time to prepare some sensible questions.

This is your first change, but get real, you're going to be changing medications quite a few times over your life span.

Offline Jim Allen

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #5 on: January 19, 2017, 02:51:44 am »
Yeah I have to agree with the others having a discussion is not a bad thing at all.

Medication and what we know changes all the time, so having a doctor who is on top of this and attentive enough to check in with you and talk about this is a good thing.
Have the conversation and see what comes out of it.

Jim
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Offline metekrop

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #6 on: January 19, 2017, 12:37:22 pm »
... I felt Atripla was doing its job well and I have learned to live with it.


So, if you are one hundred percent sure the fact that Atripla was doing the job it is intended to do, I don't see changing of medication and even to have a discussion on.  Who knows if you change the medication and the new one is not working for you???  I am also on Atripla since July of 2009 with no side effect, UD in about three month and average CD of 600.
Diag.on 12/8, 2000, CD 440 VL 44K, No Meds
12/08 - 2/09 CD< 50 & VL >500k hosp'z.
St. Atripla - 7/09 CD 179, VL 197k
10/09 CD 300 VL U
3/10 468 U
8/10 460 U
12/10 492 U
3/11 636 U
8/11 530 U
1/12  616 U
7/12 640 U
12/12 669 U
5/13 711 U
11/13 663 U
4/14  797 U
10/14 810 U
4/15 671 U
10/15 694 U
3/16 768 U
8/16 459 U
2/22 780 U
8/31 940 U
2/26 809 U
8/18 882 U
3/28 718 U
8/15 778 U
2/25 920 70
8/11 793 U
2/22 690 U
6/8 834 U

Offline Jim Allen

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #7 on: January 19, 2017, 01:14:59 pm »
So, if you are one hundred percent sure the fact that Atripla was doing the job it is intended to do, I don't see changing of medication and even to have a discussion on.  Who knows if you change the medication and the new one is not working for you???  I am also on Atripla since July of 2009 with no side effect, UD in about three month and average CD of 600.

To be honest I should not but will, what is the harm or beef you have about a doctor checking in with a patient that they are okay and giving them information and choice of current treatments options?

Patient can listen, be informed and say thank you for the information but I'm okay with what i have or choose to change.

I mean there are other factors that could be at play with the doc wanting to talk that will be more clear once the OP has the conversion.  Giving patients information and treatment choice is good.

Jim
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Online leatherman

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #8 on: January 19, 2017, 04:08:35 pm »
if you are one hundred percent sure the fact that Atripla was doing the job it is intended to do, I don't see changing of medication and even to have a discussion on.
However that's not the case here. We know that tenofovir TAF is better than tenofovir TDF (with similar or better viral load stats and fewer kidney- and/or bone- related negative side effects. Every doctor worth his or her medical degree should be speaking to every patient using TAF about the possible improvements of switching to a regimen using TDF.

A discussion about switching to a "better" regimen (whether "better" is simply easier to take or less cost for the patient, or whether "better" is an improvement in the possible long-term outcome using one medication over another) should be a discussion that patients and doctors should always be ready to have.

I can't imagine where I'd be if my first doctor, way back in 1993) hadn't suggested switching me from AZT to a 3-drug regimen. Oh wait! I can imagine - I would probably be dead from AIDS. I can't imagine where I'd be if my brand-new doctor hadn't suggested switching my latest regimen to something newer. Oh wait, I can imagine - I would still be barfing 4 days a month. I've been on 25 different HIV meds now and I'm certainly glad to speak to my doctor anytime about newer meds - especially when they reduce the negative side effects. ;)
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline bmancanfly

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #9 on: January 19, 2017, 08:31:54 pm »
Every doctor worth his or her medical degree should be speaking to every patient using TAF about the possible improvements of switching to a regimen using TDF.
I think you got that backwards.

The title of this thread implies that your doctor is driving the bus - and that you are just a passenger.  It's your life.  Consult with your doctor and use his significant knowledge to help you make a decision.  But in the end, you're driving the bus, it's your choice whether you change, not his. 



"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Online leatherman

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #10 on: January 20, 2017, 04:20:36 am »
I think you got that backwards.

The title of this thread implies that your doctor is driving the bus - and that you are just a passenger.  It's your life.  Consult with your doctor and use his significant knowledge to help you make a decision.  But in the end, you're driving the bus, it's your choice whether you change, not his.
nope. The OP and others are simply misunderstanding their doctors intentions.Their stories clearly state that their doctors spoke to them about changing to better regimens and according to stories here, the patients chose not to change. That IS the patient driving the bus and the doctors doing their due diligence offering their patients the information and the choice about changing meds. (ie the doctors consulted their patients exactly as you said).

it really is the responsibility of the doctor to use their significant knowledge to suggest changes in meds when appropriate as a patient might not always be privy to that kind of information. Atripla is no longer considered a front-line medication, as there are other regimens now with clinically proven better results, so suggesting this change was not actually as the OP or others described. the real problem in these situations seems to be that doctors aren't properly explaining the reasoning and data behind suggesting the regimen change, otherwises these patients wouldn't have left their doctors believing the change was suggested for no apparent reason or that Atripla was still the best at doing the job.
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline bmancanfly

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #11 on: January 20, 2017, 09:50:46 am »
LOL.  You completely misunderstood what I was saying while you tried to correct me about misunderstanding.

If you actually read the part of your post that I quoted,  you said "Every doctor worth his or her medical degree should be speaking to every patient using TAF about the possible improvements of switching to a regimen using TDF." 

Care to restate that ?

The rest of my post was directed at the OP and I stand by it.

To the OP, make your doctor explain to you, to your satisfaction, why he is suggesting another regimen.   The final decision remains with a well informed patient.



"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline mecch

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #12 on: January 20, 2017, 01:19:54 pm »
Don't agree with many of you.  I am not a doctor. I chose the best one in two Cantons.  He's the expert. He explains things to me.  I take his recommendations. I don't really "drive the bus". Why should I? 
If a specialist says there is a better medication to try. It means - "I think this may be a better option for your health."   

Just because something is working doesn't mean its "the best option available".
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline bufguy

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #13 on: January 20, 2017, 01:48:04 pm »
I have been on Atripla for almost 9 years with excellent results. My CD4 count is consistently over 800 and I have maintained an undetectable viral load since 8 weeks after starting. I had minor side effects for the first 4 months, but since then none.
I asked my doctor about switching to a newer "first line" regimen and she felt that there was no reason to.

I think there is a misconception that since Atripla is no longer a "first line regimen" it is inferior in treating HIV. It's inferiority stems from the fact that it produces side effects i a higher percentage of patients than newer regimens. I've been lucky as I have had no side effects.

Bottom line: Atripla is a very effective medication and I have chosen to stick with it.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .
11/29/18 vl un CD4 1080/39% CD8  .86

Offline bocker3

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #14 on: January 20, 2017, 02:30:40 pm »
I take his recommendations. I don't really "drive the bus". Why should I? 

But you ARE driving the bus -- you are making the CHOICE to take his recommendations.  He can't FORCE you to do so.

I suspect that if he recommended you do something that you really felt was not in your best interest, you would NOT take that recommendation.  Perhaps I'm wrong, but I don't think so.  If his recommendation was to take a medicine that would cost you, personally, $6,000/month because it was a bit "better" than your current - would you blindly follow?

Mike

Offline Grasshopper

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #15 on: January 20, 2017, 11:20:41 pm »
Don't agree with many of you.  I am not a doctor. I chose the best one in two Cantons.  He's the expert. He explains things to me.  I take his recommendations. I don't really "drive the bus". Why should I? 
If a specialist says there is a better medication to try. It means - "I think this may be a better option for your health."   

Just because something is working doesn't mean its "the best option available".

Bingo, I totally agree !

Offline Grasshopper

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #16 on: January 20, 2017, 11:27:10 pm »
But you ARE driving the bus -- you are making the CHOICE to take his recommendations.  He can't FORCE you to do so.

I suspect that if he recommended you do something that you really felt was not in your best interest, you would NOT take that recommendation.  Perhaps I'm wrong, but I don't think so.  If his recommendation was to take a medicine that would cost you, personally, $6,000/month because it was a bit "better" than your current - would you blindly follow?

Mike

In this part of Europe, we don't have to personally worry about the cost of medication. If it is approved by the state, then the Insurance companies & pharmacies must provide it.

Offline Jim Allen

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #17 on: January 21, 2017, 07:53:57 am »
Don't agree with many of you.  I am not a doctor. I chose the best one in two Cantons.  He's the expert. He explains things to me.  I take his recommendations. I don't really "drive the bus". Why should I? 
If a specialist says there is a better medication to try. It means - "I think this may be a better option for your health."   

Look I don't see any problem with having a conversation, getting a doctors point of view and up-to-date information can not hurt and patients & doctors should for their own good be open towards having conversations regarding treatments and options.

However I don't agree with just taking doc's recommendations if I had just done that without questioning or having a conversation (two ways) over the years I would have left the kids and my pets with the state to care for as it was not recommended for me to keep the kids and be living with HIV by one HIV consultant I had.

Just because something is working doesn't mean its "the best option available".

Very much agree with that.

@OP
I hope the visit goes well and you have an informative and constructive conversation with your doctor.

Jim
« Last Edit: January 21, 2017, 08:58:11 am by JimDublin »
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Online leatherman

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #18 on: January 21, 2017, 09:40:50 am »
...to take his recommendations.
...if he recommended you do something that you really felt was not in your best interest,
...you would NOT take that recommendation.
...If his recommendation was to take a medicine that would cost you, personally, $6,000/month because it was a bit "better" than your current - would you blindly follow?
exactly!

The doctor can NEVER force you to do take what you don't want to take (for whatever reasons, personal, factual, or financial); but it is definitely the doctor's responsibility to make those recommendations about your meds. Isn't that what you pay a doctor for? for their recommendations on how to improve and/or sustain your health??

several posters in this thread seemed to be concerned that their doctor had even wanted to discuss a regimen a change. It would only be a problem, if your doctor changed your prescription without your approval and refused to rewrite a prescription for your current meds. Otherwise I would be glad that my doctor was watching my case enough to suggest a regimen change and I would consider the change because of the trust I have with my doctor and my own knowledge about HIV and the meds
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Lightfighter

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #19 on: January 21, 2017, 06:02:19 pm »
I guess I'm on the other end of the spectrum.

I see the benefit of switching to a TAF regiment. I'm on Stribild and undetectable. I'm sure some of you remember when I first joined here and my first DR would prescribe nothing but Atripla.  So I found a new doc.

Anywho, I'm going to discuss taking Tivicay and descovy instead of Stribild.  Triumeq can have some psyche effects so I'm not chancing it. Two pills don't bother me.

Plus I'll be able to eat grapefruit and have no food requirement which will,streamline my life, and waistline.

Offline RobbyR

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #20 on: January 21, 2017, 08:13:21 pm »
I'm glad you posted, it's a very good topic. And one I struggled with immensely myself. I was on Atripla for several years, it was my first regimen, and got me undetectable FAST! And kept me that way. It was a great medication in a purely physical sense. My sex drive was through the roof, (which it isn't now), and physically I felt good. However, that's where it ended for me. Mentally, it became bad. I had pre-existing anxiety and depression, but while on this medication over time, my anxiety and depression got pretty severe, which was probably due to the sustiva. Granted, I was not in a good place overall during this time either, I had been unemployed and had suffered some pretty severe personal setbacks, so all this contributed to my stressful state too, but I'm sure the sustiva did not help. At any rate, I decided to ditch it and go on stribild, and now genvoya.

Overall I am glad I did. Atripla worked well for me until it didn't. That sustiva just messed with my head too much, and my sleep was really suffering. Everyone is different so just talk to your doctor and be relentless and ask tons of questions. Atripla is a great effective medication, but stribild and now genvoya have worked well for me and my sleep is great now and my anxiety attacks and major depressive episodes are gone.
"I survived because I was tougher than anybody else".--Bette Davis

Atripla
2010-2015

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2015-2016

Genvoya
2016-

Online leatherman

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #21 on: February 13, 2017, 04:38:36 am »
LOL.  You completely misunderstood what I was saying while you tried to correct me about misunderstanding.

If you actually read the part of your post that I quoted,  you said "Every doctor worth his or her medical degree should be speaking to every patient using TAF about the possible improvements of switching to a regimen using TDF." 

Care to restate that ?
ah! now that you wrote me a note, nearly a month later, and pointed out that in this one line I transposed TAF and TDF, I finally understand what you were talking about. don't be so enigmatic next time ;)
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Azrael2012

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Re: Dr wants to switch me from Atripla, I am not so eager
« Reply #22 on: June 12, 2017, 07:27:41 pm »
I'm having to make a switch from Atripla after being on it for 7yrs, I'm UD and CD4 is in the 700s. The reason for the switch is due to removal of it from the NHS in England due to cost. It's a disgrace given I'm the patient. My consultant is in agreement with me but he's got no control over it. So I'm having to switch in August. I will keep you posted to numbers, I'm also Epileptic and on a massive dose of meds for that. It's not controlled and the HIV is the cause.

 


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