POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: gonzo on September 17, 2008, 07:45:54 pm
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Hello everyone,
I have used these forums to find a combo that I felt would help me, I settled on Reyataz, Norvir & Truvada. After expressing my desire to try this combo to my Dr., he told me this was too many medications, that I should try Reyataz & Norvir for now.
I'm confused about this somewhat, as I had been on medication before.
Thanks!
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Reyataz must be used in combination with at least two other HIV meds.
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Send you doc back to med school.
A combo is 3 active drugs from at least 2 drug classes. This formula is recommended in US, UK and European guidelines (indeed, all guidelines).
The common drug classes for first-line therapy are: nukes, non-nukes and PIs (PIs are used with Norvir which acts as a booster to make them more effective by lasting in the body longer and this doesn't count as an active drug).
Therefore Reyataz (+ Norvir) + Truvada counts as a full combo: Reyataz is a PI , Truvada contains 2 nukes, tenofovir and FTC. This fulfills the 3 drugs from 2 classes formula.
Reyataz + Norvir does not, it's 2 drugs short of a full combo.
Hope this helps.
- matt
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Send you doc back to med school.
A combo is 3 active drugs from at least 2 drug classes. This formula is recommended in US, UK and European guidelines (indeed, all guidelines).
The common drug classes for first-line therapy are: nukes, non-nukes and PIs (PIs are used with Norvir which acts as a booster to make them more effective by lasting in the body longer and this doesn't count as an active drug).
Therefore Reyataz (+ Norvir) + Truvada counts as a full combo: Reyataz is a PI , Truvada contains 2 nukes, tenofovir and FTC. This fulfills the 3 drugs from 2 classes formula.
Reyataz + Norvir does not, it's 2 drugs short of a full combo.
Hope this helps.
- matt
Nothing to add....just reread....
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This is really the type of mistake where you need to get a new doctor, without hesitation, if you're completely sure that's what he said to you.
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wow, quick reply's, Thank you guys!, I am sure that is what my Dr. told me, and since it did not seem correct to me either is why I am asking this in these forums.
Would there be any benefit at all, from me taking just the Reyataz & Norvir?
Thanks again!
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Gonzo,
If this is your first combo, it is your best chance at choosing something that is !) easy to take 2) potent and 3) very easy in terms of side effects.
Reyataz plus the booster Norvir) plus Truvada would fill the above bill. Reyataz alone (because the Norvir is being administered in too small a dose to be an antiretroviral) would not be suppressive enough to prevent viral mutation and eventual resistance. And that resistance would, to varying degrees, cross over to other PI's, making a number of them ineffective as well.
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hmm, sounds like I'll be doing myself more harm then good by just taking Reyataz & Norvir alone, I will call my Dr., and insist on getting a prescription for Truvada, then looks like I have to search for a new Dr., sigh...
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Gonzo,
I reread your original post and saw that you had been on meds previously. Sorry for the mistake in my last post. But treatment experienced or not, it is still critical to have a regimen that is fully suppressive.
Did you have a resistance test (genotype) done prior to your doctors prescribing the Reyataz? You need to know if there are any resistance issues before you begin a new regimen.
Best...
:)
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I've been taking Reyataz and Norvir only since I switched from Prezista/Norvir only in June.
My latest t-cell count (426) was the highest it's been since October 2005; viral load still undetectable and % up to 26.
It seems to be working okay for me. My doctor did warn me that it may not keep viral load suppressed in the long term but here and now is all I'm concerned about.
Just another perspective.
Emma
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I had my Dr. call my Pharmacy for the Truvada, but after reading gemini20's post, I might wait a month and see how my body adjusting to just the Reyataz & Norvir alone before adding it, does that seem like a good idea/bad idea?
Thanks again!
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Hey Gonzo,
With all due respect to Emma's perspective, it really isn't a viable option.
Taking just Reyataz with a 100 mg Norvir boost is, in essence, taking monotherapy.
If such a regimen worked, we probably would have a lot more long-term survivors around because AZT monotherapy would have worked.
Would you be satisfied, or feel safe and confident, taking just AZT?
If you answer yes, there is nothing more to be said.
If you answer no, then why would you feel comfortable taking just Reyataz. Remember, the Norvir isn't in sufficient strength to be considered a second part of the regimen. It is just there to boost the effectiveness of the Reyataz.
If you pursue monotherapy, you could screw yourself out an entire class of meds.
What you do is up to you though.
Good luck.
HUGS,
Mark
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I had my Dr. call my Pharmacy for the Truvada, but after reading gemini20's post, I might wait a month and see how my body adjusting to just the Reyataz & Norvir alone before adding it, does that seem like a good idea/bad idea?
Thanks again!
Again, with all respect to Emma, in my opinion, that would be a very bad idea. There are a few ongoing studies on boosted PI monotherapy (I think Matt is participating in one?), and there have been a couple of studies on Kaletra monotherapy in patients whose viral loads were undetectable after 6 months of HAART, but few clinicians would prescribe PI monotherapy outside of a study setting unless there were overriding concerns about toxicity.
You said that you had decided on the Reyataz/Truvada regimen. Is your hesitance due to the conversation with your doctor, or are there other reasons you don't want to take the Truvada?
If you haven't started anything yet, I urge you to get a second opinion, before starting on this course.
Best...
:)
edited for my customary typos!...
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I had my Dr. call my Pharmacy for the Truvada, but after reading gemini20's post, I might wait a month and see how my body adjusting to just the Reyataz & Norvir alone before adding it, does that seem like a good idea/bad idea?
Thanks again!
No, this is absolutely the worst thing for someone on this board to recommend. Ignore Emma.
I'm resistant to an ENTIRE class of HIV meds, and partially resistant to another which led me VERY few regimen options for years. This was due to disastrous mono and dual therapy regimens EXACTLY like Emma is recommending that were used in the 90's. Consequently I had to go on Fuzeon and inject myself twice a day for 2 years -- do you REALLY wish to end up in that situation.
I appreciate that others here are willing to say "all due respect to Emma" (and I harbor no actual animosity to her) but frankly I find it very irresponsible to make the recommendation that she did, especially considering her past rather unsuccessful history of playing "I'm the doctor" if you read her older posts. I really don't think hovering slightly over 200 t-cells in AIDSland is a great way to go.
Sorry, but I just feel very strongly about this. I'd say the chances are around 95% that you'd develop resistance, and to take the advice of that other 5% is simply extremely misinformed.
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"Ignore Emma" might be a bit harsh, but follow her at your own risk. What she and her doctor are trying is still considered experimental, and all the current treatment guidelines recommend AGAINST it. So if you want to try an experimental regimen, with all the risks that entails, be our guest.
Peter Staley
Founder
AIDSmeds.com
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I appreciate that others here are willing to say "all due respect to Emma" (and I harbor no actual animosity to her) but frankly I find it very irresponsible to make the recommendation that she did, especially considering her past rather unsuccessful history of playing "I'm the doctor" if you read her older posts. I really don't think hovering slightly over 200 t-cells in AIDSland is a great way to go.
Excuse me but I don't think that anywhere in my post I 'recommended' my current regime.
What I did say was It seems to be working okay for me...Just another perspective.
Surely sharing our own personal experiences is what this forum is about.
And for the record Philly267 I'm not sure what you mean by my "unsuccessful history of playing "I'm the doctor" but all I do know is I'm still here after 17 years, never had any OIs, and not resistant to any meds even with three treatment breaks behind me; oh and my t-cells are now over 400 (seems you missed that bit in my post).
Emma
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is your QUACK , oh i meant doctor , trying to save your HMO MONEY ?
it sounds crazy to not use rayataz, norvir and truvada !
TOGETHER !
find out if he really has a clue .does not sound like something I would let my doctor get away with !
MAYBE you are an experiment ???? ASK HIM !
good luck !
it's been MY cocktail for 4 years !
peice of cake !
karl
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Thank you all for your input, I would like to clarify something, in my original post I stated I had settled on Reyataz, Norvir, & Truvada combo-this hasn't changed.
gemini20 was not recommending anything to me, please reread her response to my post, infact I was suprised by it, at first I thought maybe there was some kind of validation for my Dr.'s statement, but nowhere did I write I was following her.
To be honest I am scared to take all these meds at once, as I have been suffering from severe "unspecified rashes" for the past year, and I wanted to know if it was okay to take it slow with these meds-would waiting 2-4 weeks to add the Truvada while my body adjusts to Reyataz & Norvir be fine?
I do agree with everyone who said find a new Dr.
Thanks again!
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no
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Combo does most of it's work to suppress viral load in the first month. Therefore hitting it hard at the beginning will be more effective.
The risk of starting Reyataz first and adding Truvada later, especially with a high viral load, is that the drug pressure is too light and don't push your viral load down, giving the HIV a chance to adapt and develop resistance.
Consider also that unspecified rash may be related to HIV. And combo will kick this in the head.
Maybe 8-10% of people get a rash on starting Reyataz. If you do decide to start this early, maybe just 2 weeks?
Reyataz being a PI, the a risk of developing resistance by using it without the nukes for a short time is low. But, it's non-standard, not the best known way to use the drugs, and perhaps, in military terms (because this is the frontline of the fight against AIDS after all) like going in with ground troops without air support.
Emma's result is interesting (and deserves a hurrah!) -- added to the other small studies on boosted PI monotherapy, suggests a single boosted PI may be viable as maintenance therapy, that is, when your viral load has been <50 for some time. I am (as noted, somewhere..) enrolling on a radomised controlled trial which will test this exact question. But as Peter says, it is experimental (hence the study).
- matt
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Combo does most of it's work to suppress viral load in the first month. Therefore hitting it hard at the beginning will be more effective.
I did not know this, thanks for enlightening me, I see a month wait to add the Truvada will be too long now, I will add it in this week.
Regarding the Reyataz rash, I guess I fall into this 8-10%, since I already am prone to rashes, a few hours after taking it, I turn slightly red, and get intense itching, I hope this lessens with time because it wakes me up from sleep.
Thanks for the info.
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Hey Guys. I'm a newbie here. Was diagnosed last february and ignored it as part of the shock of the diagnosis. I went to full blown AIDS last october and got PCP then soon after, a spontaneous pneumothorax which almost killed me. Now a have a new outlook on life and living. Reyataz/Norvir/ Truvada was my combo picked after the phenotypic and genotypic testing. I went from 28 T cell to now 206 as of July 08. My viral load was 90,000+ and now undetectable. I did have a slight prickly rash which developed as soon as I started the meds. I was also on PCP prophylaxis (Bactrim) till April 08. I'm just on the combo and nothing else. Well, I am taking 1200mg of flax seed oil, 1000mg Vit c and high strength fish oil to prevent any elevation in my cholesterol and LDL's. So far so good and no side effects. Thank God! It's encouraging to share these blog with you guys and also a great help to read yours as well. .....Tim
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Welcome to our forums, Tim, and congrats on the great lab numbers.
Peter Staley
Founder
AIDSmeds.com
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Hello all,
just thought I'd update to let you know that I have been on Reyataz & Norvir for 1 week, and tonight am adding the Truvada to the mix. My side effects of redness and itching are slowly subsiding, to the point of tolerable. Regarding the Truvada, anything I should look out for side effect wise?
Many Thanks!,
G
P.S. timpoz your post was very uplifting, I hope I get similar results too! ^^
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Explain to me again why you are doing this in that manner?
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I wanted to take it slow because I had been experiencing 'unspecified rashes' on and off for the past year, and this way if I did have a severe reaction, I could pinpoint which drug was the culprit more easily.
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gonzo, timpoz here... i too had unspecified rash on my upper arms, upper chest, lateral abdomen, back (upper back behind the shoulder blades). well, mine looked like prickly heat but nothing in clumps like in a regular heat rash. these were pimple like. it looks like i'm going thru a second puberty with skin hormonal changes. ugh! i hope that helps. it got better over time. my best suggestion is to take a couple of showers a day and use an antibacterial soap like dial or som'm. give yourself a good scrubbing cloth from BB&B (Bed, Bath & Beyond) and have yourself a time of your life in the shower. but then again if you could have someone there with you doing it for you, more power to you. i guess your back isn't the only thing getting scrubbed. LOL! basically... reduce your bactrial skin flora & oily skin down as much as possible. let me know how that goes.
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timpoz, I really appreciate your advice, but my initial rash was so severe they kept me in the hospital for a few days, and gave steroids intravenously. It started out as hives on my neck and face, and shortly spread thru out my whole body-head to toe. They took a biopsy, but nothing conclusive came out of it, since then I've had 2 flare ups, but nothing as bad as the first time.
I been using unscented soaps and deodorants, and laying off the cologne, until I feel confident I won't have this happen to me again.
This is why I was reluctant to take all my ,meds at once, incase I had a reaction, but I must say it's been a week since I'm on all the meds, and it seems my fears were unfounded, so far so good!
Again I must say I was delighted to see how well you are doing on these meds, it gives me hope for myself!