My Doctor recommends I “Upgrade” my meds…

[BKKKevin]

I was diagnosed in 2016 and put on Complera… I have been undetectable, with a CD4 that has never been below 500 and all my biannual liver/kidney tests show no problems… My primary physician has retired and now I have a new doctor who is very nice… She at the end of my last 6 month review said my status was excellent but recommend that I should “upgrade” to a newer med… (Odessey or Vikarvy) as they are less prone to liver, bone damage or resistance…. While I want to have the safest and most effective treatment I am reticent to move from my present drug as it has worked perfectly - Starting a different drug opens me up to possible side effects. My guess it she is new and unfamiliar with Complera as it is not a new frontline drug that she regularly prescribes…

My question is Odessey & Vikarvy substantially better or is this just drug company hype to move me on to a freshly patented more expensive (but basically the same) drug?…

My US insurance/copay card pays for all of this but in a few years I will have to move to Medicare which will not cover the med cost 100%… Complera may go generic in the US by then and can be sourced in Thailand for $30/month!… Also I have built up a 6 month supply of Complera that allows me to travel for several months without worry about being home to get my monthly prescription - I hate to lose this flexibility and piece of mind…

[Jim Allen]

The only difference is that Odefsey contains a newer form of tenofovir. (TAF)

Complera is emtricitabine 200 mg/ rilpivirine 25 mg and tenofovir disoproxil fumarate 300 mg vs Odefsey is emtricitabine 200 mg /rilpivirine 25 mg and tenofovir alafenamide 25 mg

I have taken TDF before, and it wasn't my cup of tea, now, with my current regime that I am happy with my own doctors do recommend newer treatments from time to time, but when I ask why and based on what evidence is the newer treatment supervisor than my current treatment or what evidence do they have that my current treatment is an issue specifically for me, the conversation ends rapidly.

TDF and TAF, like any medication, can cause problems in some people; in short, TDF has the edge over TAF regarding blood fat levels and weight gain. TAF may be a better option for those at risk for kidney or bone problems, but both are safe options for most people.

https://www.poz.com/basics/hiv-basics/taf-versus-tdf-difference

I would get a second medical opinion before switching, and keep in mind that you are in the driving seat.

[leatherman]

switching meds is always tricky. You want the good stuff and don't want to get the bad stuff.

Starting a different drug opens me up to possible side effects.

After having taken 25 different meds over the last 28, I had the good changes, and the incredibly bad ones too. When I make this decision I come to it as a very cautious person. I'm not really a gambler at all, so I want good odds.... like the best odds. If I can't easily see the possible best odds, then I have to balance it against how good my current regime is working.

While I want to have the safest and most effective treatment I am reticent to move from my present drug as it has worked perfectly

consider what "the safest and most effective treatment" means to you. I know people still taking Atripla and even older drugs, because when it ain't broke, don't fix it. If you have no negative side effects...and not just HIV-related. How's the BP, cholesterol, iron, etc., all that stuff in the CBC blood test. If that, stuff is all good, and has been for a while, well that means for me that I want the bestest odds if the doctor is going to convince me to change. My last change was almost a decade ago to Prezcobix to get rid of that bane of my existence: norvir. ugh. gross. gag. blech.


my other considerations would be (as you mentioned): price, availability, backup supply. Your current status on all those might influence you to tell the doctor you would rather re-evaluate the situation is another 6 months or year. If you health status and financials aren't requiring an immediate change, then really you have all the time in the world to consider this issue.

Heck, even I consider a med change once in a while, just because. Several times, I have told my doctors that I wanted to change (presenting valid reasons). Once I even told one doctor about a med change before he even knew it was available (switching gelcap norvir to the slightly better norvir tablet). But right now the two I take are doing fine and there's nothing super special extra out there to switch to. one pill? 2 pills a day? I used to take 28+ a day so I'm not a stickler on a one a day regime. Besides, I'm also taking acyclovir, fluconazole, and Atorvastatin. one less pill really won't fix my "pill burden" LOL. I even can't be persuaded that the 6 times a year to the doctor to get the new injectable is somehow better than downing 2 pills a day.


Good luck on your decision soon or some time in the future on this issue!

[BKKKevin]

https://www.poz.com/basics/hiv-basics/taf-versus-tdf-difference

Jim thanks for the excellent analysis link!…
And Leatherman thanks for the wise counsel of your experience…

It reaffirms my feeling that if it isn’t broke no need to make changes…
I’ll stay with what’s working as the minor benefits of a new drug don’t outweigh the potential side effects that they may bring on…

[kentfrat1783]

I've only changed med once and that was due to my insurance saying they were no longer going to pay for the Rx I was on. 

Like the others, ask how is this new Rx is going to benefit me and what possible side effects are their.  I'm not one to change to change, but if the pill is causing some lab to get out of line then I'd be up for a talk about switching. 

Until then I'm good with what I am on.