Changing Meds Atripla to Truvada+Raltegravir

[monarcmarc]

Hi All,

I felt as if I was having difficulty being heard in relation to my concerns about the cognitive effects of Atripla. I had quite a bad spell a few weeks ago. I had an exam, forgot to take my tablet (my adherence generally is quite good, In the last 16 months I've missed three doses, two of which I ended up taking a little late). Upon realising, I took the tablet, and then took that days tablet as well at the ordinary time, even though it was just inside the 12 hours until my next dose.

For the next couple of days I had a pretty rough time in terms of my mental health. It really felt as if this depression had just kind of plonked itself down on my shoulders for a few days. It was very unpleasant and it was unusual, I'd not experienced a quite noticeable side effect like that previously. I understand that there is a difference between correlation and causation, but to my mind the two are related. I was able to speak to a treatment officer at ACON who suggested that there may be a causative effect. I had an appointment with my ID Doc last week and he has suggested to me that I swap to Truvada and Raltegravir.

He didn't like Eviplera (Complera) because on starting Atripla my VL was > 300,000. I was also a bit hesitant with respect to the dietary requirement. I know a lot of people are able to take this very effectively with a little thought and planning, but the thought of potentially not getting the right levels was disconcerting to me.

Most I have spoken to have sought of sung the praises of the proposed change, and it is a combo that I had been leaning towards as the literature suggests it's pretty awesome, potentially with a greater capacity to suppress the virus than Atripla, which is important to me given my VL was relatively high when I started treatment (though my CD4's have not fallen below 800).

My concern is that I know that Atripla is a little forgiving in terms of dosage timing, with doctors suggesting up to 5 hours variance is not problematic.

I'm a little concerned about the Raltegravir. It will be twice dosing initially (although the ID Doc suggested that once you are able to sustain an UD VL, then once daily dosing may not be problematic).

Couple of questions:

Do I have a little bit of leniency here with Raltegravir. Is it forgiving by a couple of hours if schedule requires it, or it will I need to be particularly vigilant. That the twice daily dosing seems to be preferred over single dosing initially seems to suggest that it is important that in order maintain correct levels in the blood it really needs to be taken strictly 12 hours apart.

Further if you are not strict, what is the (and I'm making up my own terminology here) mutation profile like. I thought I had read that Raltegravir is slightly more prone to resistance issues than Atripla, but I don't know if I am recalling correctly and can't seem to find the info. Would anybody be able to share their thoughts experiences or any literature on this aspect of the combo.

I want to have as much information before I swap over as I'm told swapping back is not problematic, but requires a bit more thought and planning than the initial swapping to this combo requires.

Any thoughts and advice or experiences will be gratefully appreciated.
Mark

[monarcmarc]

Just to clarify, I'm unlikely to start until Mid Jan, as I have a study tour in China and I just feel it would be better to try and bed down a new routine when there is a bit less going on, with time zones and different routines etc.

Cheers