kidney problems with Truvada... 3rd med change since Aug

[Dan J.]

I have had 3 med changes since Aug. I was on Reyataz, Norvir, & Truvada. Due to having a high creatine levels doc changed that combo to Reyataz, Norvir, Epivir & Zerit. After my recent stomach problems they changed meds again to 4 once a day of the new Kaletra & 1 Truvada. Since being on that combo for 3 weeks (the doc has been checking kidney function weekly) Doc called me this am and told me my creatine levels were high again so he changed my combo to 4 once a day kaletra with Epivir & Zerit. I would prefer to not have to take Zerit due to neuropathy problems & I really need something that is a once a day combination. I have problems being ad hearant to a multiple dose med regimen. I am allergic to sulfa based drugs & have had problems with Sustiva & Ziagen so those two are ruled out. Doc told me he could put me on just 4 once a day Kaletra but is afraid I could develop resistance to it, so he didn't. I'm at a loss here and need suggestions to discuss with the Dr. I have an appointment next Thursday for weekly blood work.  I asked him this AM when the last mutation blood test was done on me , he told me 2003. I asked him if it would be a good idea to do that again & he told me that since I am probably still undetectable that it wouldn't show anything. Any help would be greatly appreciated.

Dan J.

[heartforyou]

Danny,

As long as the meds can keep you undetectable, the change of meds remain an unpleasant but necassary tool.
I know it hasn't been easy for you lately.

Things will fall into place soon.

Love u

Hermie

[newt]

Okay, so yr doc has chopped n changed you from Truvada to Zerit n back, because those drugs are no good for your body.... hmmm

Let's talk about Zerit (ow!, my feet hurt) ...

Zerit does not get you off the kidney hook. Zerit is cleared from the body mainly by the kidneys.  The dosing for Zerit can be adjusted by weight. Standard doses: 60mg/day if less than 60kgs and 80mg  if 60kgs+.  A reduced dose is effective though (study was done in Thailand): 40mg/day if less than 60kgs and 60mg if 60kgs+.  The dose can be lowered further if your kidneys take a long time to clear the drug, as low as 30mg or 40mg a day according to body weight.  60kgs = 132lbs (just under 9 ¹/₂ stone). A lower dose tends to cause less side effects (ie PN).

Truvada/Viread

Tis the Viread in Truvada causing the kidney problems.  Like Zerit, the dose can be adjusted according to your creatine clearance (not creatine level in the blood).  As low as 1 Viread tablet a week.  But, me personally, think some of the dosing schedules, like a Viread every other day, are just too hard.

Something to consider: Videx

Likewise Videx EC (ddI) is adjusted by weight and for creatine clearance.  It is a kinder than Zerit for PN etc but still causes problems for some people.  An advantage with Videx is the adjustment is always to a lower dose 1 x day.  A downside is having to take it on an empty stomach, ie different time to other drugs. However, time of day ain't that critical, and it maybe a workable compromise v taking Zerit/Viread (again).

Short answer about using these 3 nukes: if you take any of these nukes, yr doc needs to establish you creatine clearance and suggest an adjusted dose based on this figure. 

Another thing to consider: 2 x PIs 1 x day

This is possible, and with summat like 3TC, makes a workable, even good combo.  Need to watch the lipids but not always a problem. Reyataz + Kaletra would work, but, although technically "experimental" Reyataz + Invirase, with 100mg or 200mg of Norvir booster (100mg prob. enough) would too, and prob. be kinder to lipids.

Outside option: Kaletra or boosted Reyataz +3TC or FTC

Since you are undetectable, and multi-dosing schedules not your preference, this may be viable for now.  The results from Kaletra monotherapy have been reasonably good.  The nukes do something though, and yr doc is right to highlight a chance of resistance.  But, PI resistance evolves slowly, and it may be the best option right now until new drugs come along.  It may work for long enough for new non-Zerit non-Ziagen non-Viread options to appear.  Indeed, it may work indefinitely. You may also be able to do this with Reyataz (if so I'd go for a 400mg dose of Reyataz rather than 300mg). FTC prob. better than 3TC in this context.

Hope this helps

- matt

[Dan J.]

Thank You Matt.

Dan J.