Why are some treatments second line treatments only?

[JamieD]

I am just wondering why some drugs are recommended only for treatment experienced patients? Aren't all drugs good so long as they suppress the viral load? If you aren't resistant to that particular drugs shouldn't any drug suffice no matter whether you have taken other drugs or not?

Someone help me, because I don't know anything about this.

[aztecan]

Hey Jamie,

Actually, some of the second line of treatment today were first line at one time. I call it drug du jour.

Some of the newer drugs are used because they are easier to take or have fewer potential side effects. An example would be Kaletra, which has been demonstrated to be more lipid-friendly  than some of the other PIs.

Some drugs also have more potential long-term side effects than others, especially some of the the older drugs - which were first line (or only line) not too many years ago. An example of these are Zerit and DDI or DDC (which I think they've stopped producing).

I don't usually pay too much attention to the "drug du jour," but rather what works for me. I am now taking a "first line" drug that is making me miserable and plan to switch.

I hope that helps.

HUGS,

Mark

[JamieD]

Well, like, Prestiva (did I spell that right? I think its darunavir) is said to not be used except for second line therapy in the Journal of American Medical Association.

Its a brand new drug, and I just don't know why.

[thunter34]

Some of the newer drugs are used because they are easier to take or have fewer potential side effects. An example would be Kaletra, which has been demonstrated to be more lipid-friendly  than some of the other PIs.

Wow.  Kaletra is MORE lipid-friendly?  My blood lipids have been through the roof on it.  Before Crestor, I bled butter.

[Smoothstone]

Zerit is not obsolete. I continue to take it since obtaining it in a clinical trial back in 1997. There is a very small subset of people who have an allergic reaction to Zerit but otherwise its a good alternative to other nukes which have horrific side effects. Zerit has good brain penetration. I was in a dementia trial and with-in 3 days of getting the drug I could feel my "old self". Its quite a remarkable experience when you feel your mental capacity return.

And side effect wise...I have been very lucky with no lipodystrophy to date. I take the combo of zerit,viracept,and rescriptor. I occasionally, maybe once a month, experience "surprise diarrhea" thinking I am going to pass gas, "fart" ,but its small amount of fluid.

I dropped several other drugs because of side effects and would take them in the future to survive, but only if they were the only options available. We were truly guinea pigs when these drugs started to be used. Some front line drugs, then they were "only line" drugs,  have been moved to "second line" based on the community experience gathered overtime.

Individual differences continue to make drug decisions a puzzle. Some of us experience noticeable and intolerable side effects while others taking the same drug or combo report no problems.  This of course adds to the stress of making treatment decisions. Routinely report side effects to your doc.

[redhotmuslbear]

Well, like, Prestiva (did I spell that right? I think its darunavir) is said to not be used except for second line therapy in the Journal of American Medical Association.

And who says JAMA is an HIV authority?  I would look at resources focused on the HIV community like projectinform.org or thebody.com , not trade publications that cover a wide range of health topics

[lostboy]

I have also wondered about this. Are there studies being carried out that show if maraviroc or TMC-125 would make an effective first line therapy? It seems to me that CCR5 inhibitors would be the perfect first line treatment before the tropism of the virus changes.

[aztecan]

Hey Phily,

Whoops! I was thinking Reyataz and wrote Kaletra. I have been discussing so many meds with the doc this week I am getting loopy.

Well, that and that damn Sustiva.

Anyway, I stand corrected. If you bleed butter, can we rub our bodies together and then lay out to get at tan?

HUGS,

Mark

[aztecan]

Hey Smoothstone,

No, Zerit isn't obsolete, but it is no longer considered a first line drug. That is based on its propensity to cause peripheral neuropathy as well as lipoatrophy.

But, as you said, it works great for you and I know a few others who take it and are doing splendidly.

I took Crixivan for years without many difficulties. Others have not been able to tolerate it. Some even lost all of their body hair.

It really is an individual thing and each person has to see what works best for them.

HUGS,

Mark