TIme to switch, Stribild or Triumeq??

[AaronbytheC]

So I have been on Atripla for a little over four years now.  For the most part I love it.  It’s easy to take at night as I go to bed and it’s constantly kept me UD and CD4’s of 700+.    

However over the past year, slowly but surely brain fog has crept in causing me to feel, well lost and reserved at work…  I feel like I’m sleep walking for half of the day, constantly second guessing myself.  My once pleasant vivid dreams have turned dark and confrontational.  I wake up a few times a night, my heart racing and fighting mad from these dreams.  The only way to avoid them is to drug myself up with sleeping pills to sleep through the night…  Of course this just adds to the foggy, groggy feeling in the first half of my morning.   

My doc said it’s the Sustiva messing with my nervous system and it’s time to change.  She suggested Complera, Stribild or Triumeq.  I’ve read as many posts as I can find here on all three but since they are newer combos I thought I’d ask for advice from people who are on one of them but may not have posted their experiences with them.

• From what I’ve read Complera needs 400+ calories of food.
• Stribild goes best with some food, but not a big need for 400+ calories.
• Triumeq, well that one I’m not seeing much on just yet.

So as I said earlier I usually just brush my teeth and pop an Atripla and head off to bed.  This has work really well for me and I have not missed a single does in four + years I've been on Atripla.  (Serious, not once!)  I’m thinking the Complera is out for me because the only time I constantly eat 400+ calories is lunchtime which would require me to take drugs to work with me and on the weekends…  I just see this as a recipe for missed doses. 

So that leaves me with Stribild or Triumeq.  Does anyone who is taking one or the other take them at night before bed?  If so do you eat a little something, say a granola bar or a yogurt?  Are you happy with the regiment?

Thank you in advance for your responses!

~Aaron

[buginme2]

I've been on Atripla, Complera, and now Triumeq.

I really got into a groove with Atripla taking it at night, as you are.  When I switched to Complera I had a hard time adjusting.  The meal requirement was an impediment for me.  I could no longer take it at night and since I work with an often times unpredictable schedule taking the med at a full meal became an issue.  I ended up actually hating my meds.  I developed "pill fatigue."  I would skip Complera if you feel you would be in the same boat.  As far as side effects go.  Complera was a thousand times better than Atripla.  All the negatives of Atripla were erased immediately.  The only bad side effect of Complera is it gave me gas sometimes (the bigger the meal the less gas...just FYI).

I switched to Triumeq.  1.  If you do switch you need the HLA-b test first. 

I take some other meds for non-HIV things and I take those first thing in the morning as soon as I wake up.  I now take my triumeq with it.  You can take it with food or without.  I take it with my morning coffee and whatever breakfast I have (even no breakfast on some days).  There are no side effects.  I adjusted to it immediately and no longer miss taking it at night. 

I've never taken Stribild so I can't comment on that.

PS.  I think your post is a rather common occurrence.  I could have written it.  I feel like I've experienced everything you wrote.

[AaronbytheC]

Thanks for your input, I'm getting tested tomorrow for the gene conflict Triumeq can have. 

Any reason you are taking it in the morning rather than at night? 

[buginme2]

Any reason you are taking it in the morning rather than at night?

It's easy. Wake up, take my pills, have coffee, bite to eat, out the door.  I don't have to worry about meds or pills or anything for the rest of the day.  It turned out to be better than taking it at night.

[madeindetroit]

I'm on stribild and take them with lunch.  I have a phone app that works well to remind me to take my pill.  Medisafe...its free.  I haven't tested the little portion of food issue since I take with lunch...although at first when I was high stressed about my diagnosis a piece of bread with peanut butter was all I ate

[Matts]

no problems after 6 months of Triumeq. I take it in the evening cause the pill doesnt like supplements. Reportedly they reduce the Tivicay level up to 50% or something like that. On the other hand it is not a problem if U take the pill with a meal.

[AaronbytheC]

no problems after 6 months of Triumeq. I take it in the evening cause the pill doesnt like supplements.

So do you take it at bed time without food? 

Ideally that's what I'd like to do with a new drug, it's worked really well for me with Atripla to just take a pill and got to bed.   

[AaronbytheC]

I'm on stribild and take them with lunch.  I have a phone app that works well to remind me to take my pill.

How do you manage to make sure you have meds with you every day at lunch? 

Remembering to take my meds would probably not be my problem...  Access to them would be.     My work schedule has me here, there and everywhere so I'd have to carry one on me at all times rather than a nice little weekly pill box next to my tooth brush with one pill in each slot.

[madeindetroit]

I have a pill box that I fill on Sundays....from that if I'm not going to be near my pill box i put a pill into a water proof pocket pill bullet that I carry on my key ring.  When the phone app rattles its time to eat and pill.   Luckily I have an office job that makes it easier....but weekends that little pocket pill fob does wonders

[madeindetroit]

My breakfast and dinner times are all over the place for me so my most consistant meal is a 130ish lunch....that's why lunch works for me.  When I started taking pills what i thought take the same time everyday meant just that with no variation whatsoever or I would die LOL.  Now that I have relaxed a bit my lunch time is consistant enough to take the pill on a "scheduled time"

[xrel0aded]

I was treatment naive before I started Triumeq two months ago. The first couple days were alright, then after that I experience terrible panic attacks/anxiety, sweaty palms, extreme joint pain, nervousness, shortness of breath, and this annoying sense of impending doom. Most of the symptoms have since subsided, though I still get weird random panic attacks and my hands are really sweaty and shaky most of the day. I attribute it to the Triumeq just because I never had a single symptom such as this before taking it. Who knows, it could be something else though.

[drewm]

Just switched from Atripla to Triumeq within the last couple of weeks. No noticeable side affects just waiting on first labs.

[ChavinKnight]

Hi Aaron,

I've been on Stribild for just over a year.  It is the only medication I've ever taken so I have nothing to compare it to....I take it every evening plus or minus an hour.  If I've eaten in the last hour, I call it good, or if I feel like it, I'll have half a sandwich or something.  Eating is not a huge deal from what I can gather, you just want something in stomach.  My doctor says it has a long enough half life that it is forgiving of flexible administration windows.  As an aside the UK guidelines that I've seen say if you miss a dose, you should still take it up to 18 hours later, otherwise wait for next dose.  In the beginning, I had some fatigue in the afternoon.  Dreams come and go, but nothing unpleasant, but sometimes vivid and intense.  Not sure if that is the medication though, since I've been an intense dreamer my whole life.  I'm satisfied with it.  Easy to take, no real serious side effects yet .... Hope this helps.

[AaronbytheC]

Thank you all for your input!  Please keep it coming, all of your experiences are helpful to me as well as any future readers of this thread in the same situation. 

I had a blood draw yesterday for the gene test for Triumeq...  I thought it was going to be just a little finger prick but they took four tubes out of me!    Maybe I should have asked what this test cost before agreeing to it!  LOL

[bmancanfly]

You are currently on three drugs,  Sustiva, tenofovir, and emtricitabine.   The combo of tenofovir and emtricitabine is known as Truvada.  So you are on Sustiva and Truvada.

Most probably the cause of the issues you are having are caused by the Sustiva.  You could just switch out the Sustiva and replace it with Tivicay (or an NNRTI) and keep the Truvada portion.  Less med changes,  less chances of a new side effect.

Triumeq is Tivicay combined with Epzicom (that means three new drugs for you).   If you combined the Tivicay with Truvada you would only be changing out the portion of your current regimen (Sustiva) that is actually causing you the problem.   

Tivicay was combined with Epzicom as a marketing decision.  It is not necessarily the most efficacious combination.  Truvada has a slightly better efficacy than Epzicom and the jury is still out on the cardio vascular risk with Epzicom.

You will have to take two pills once a day with Tivicay and Truvada,  instead one one pill once a day with Triumeq but that doesn't seem to me to be that big of a deal to me.  You,  and your doctor, may decide differently.

Limiting yourself to only "one pill" options may not be in your best interest.  Pill count mattered when people had to take ten or twenty pills a day,  not one or two.

I don't want to lead you to believe that there is a huge difference between Epzicom and Truvada,  but there is a difference.  I wouldn't overlook that difference simply for "pill count" .

Either way I'm sure you'll do well.

Best of luck.

[vertigo]

Let me second the endorsement for Truvada+Tivicay.  It's two pills, but only once a day so no big deal.  No food requirement.  Everything bmancanfly just said is totally on point.

[GoForIt]

+1 Truvada/Tivicay

[AaronbytheC]

Thanks for the input, something more to think about. 
Question though: Wouldn't two pills require two copays? 
I guess I'll have to talk to my insurance about that one.

Totally off the subject but I learned a hard lesson this year about ADAP...  If you marry your partner they add both of your incomes and then divide it in half.  In my case my husband makes too much money so they assume I make over $50K a year.
 
All I have to say to that is "He married me, not my pet virus!"    
It's not his responsibility to cover my meds...

[buginme2]

How much is your Copay?

They both have Copay cards

[Niceguy2013]

Anyone have info on the cost and coverage of the HLA-B*5701 test for Triumeq? I'm interested in discussing a switch from Atripla on my next appointment, but I've depleted most of my HRA funds.