Buck746 Introduction thread - Switching meds with limited choices

[Buck746]

i have been on kaletra/truvada for ~15 years and would like to switch to an easier regimen...mainly to lessen gastro side effects, better lipid profile and once a day dosing...but i have a complicated previous treatment history..

i requested a genosure archive test done since my vl is ud with the occasional blip of 20-70 but never higher and cd count of ~1100..poz for nearly 40 years...

i just received the results that show i am resistant to all nrti's and nnrti's... but sensitive to all PI's and II's (since i have never taken any II's)..i am meeting with my dr in a few weeks to discuss but really do not know what options i have...

if i am resistant to truvada as it states is it doing any good at all  or am i really only on a monotherapy of kaletra and if so what could i switch to as a single agent if that is truly what i am on now that seems to be controlling my vl...or what other combo would work that is better tolerated and simpler dosing..ie once a day...

interesting side note the mutations it shows for truvada (4) are also listed with all the other nrti's so i really never had a chance of that being a truly new medication once started as a new med...

i have the results of all the archived mutations but do not know if there is someone or somewhere i could present the results to give me options going forward ...

i want something that is durable and don't want to try something only to fail and cause further mutations since my choices are limited...

i like my dr but do not have a total confidence that he has the right answer so would like a second opinion if you will...

there used to be an "ask the experts" at thebody website but since they changed the format it appears as though they must have phased that out as they haven't answered any new questions since april 2019..

any guidance would be much appreciated since i am pretty much shooting in the dark albeit with more information than i had before the archive test was done..

thanks in advance for any guidance or suggestions..

[Jim Allen]

Hiya,

Welcome to the forum, sorry to hear about the resistance profile and even more sad to hear you have somewhat lost faith in your Doctor.

Nobody here is going to be in the position to recommend you a treatment, just saying that up-front although a little bit of brainstorming can't hurt as long as you run idea's by your doctor.

if i am resistant to truvada as it states is it doing any good at all  or am i really only on a monotherapy of kaletra

Some resistance would not mean not working at all and even if you had full resistance to both Tenofovir disoproxil fumarate + Emtricitabine (Truvada) then the Kaletra is a combination of Lopinavir + Ritonovir so utterly nothing mono about it.

i am resistant to all nrti's and nnrti's... but sensitive to all PI's and II's

I don't know maybe;

- Prezista (darunavir) + low-dose Norvir (ritonavir) AND Isentress (raltegravir)
- Tivicay 2x daily + Norvir (ritonavir) (Not very sure about this but I am sure somewhere this combo was mentioned, maybe in a study about resistance )

I am sure there are more but maybe instead of thinking too much ahead, your VL is suppressed and you are managing, for now, so instead see what combo's the Doctor comes up on your next appointment with and get a 2nd Doctor to give you their view.

Jim

Updated with new links to the updated drug charts, 1st of July 2019.

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Single-Tablet Regimens
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PIs)
Integrase Inhibitors
Monoclonal Antibodies
Entry Inhibitors
Pharmacokinetic Enhancers


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Click for treatment recommendations.

 

[ZachR]

There was a new drug approved recently called Fostemsavir for extensively resistent strains. Additionally, you are not resistent to PIs and IIs which open doors to many possible combinations. Dolutegravir and Bictegravir are the newer IIs with a very high resistence barrier and a couple of newer ones are on their way to approval. There are entry, attachment and maturation inhibitors too. I think there are many possible ways to make a good combo, but again it all depends where you are in the world and which ones are available.
PS: There are different dimensions of resistence, and resistence doesn't necessarily mean the drug isn't working at all.

[Buck746]

thx guys...i guess i could have shortened this to ask if a drug continues to work even with resistance partial or otherwise...if that is indeed the case then i have a smorgasbord of options...

definitely want a break from kaletra ... i have been taking so many other drugs to get the lipids down and they cause really bad leg cramps and pain thought there must be a better way....didnt really want to rock the boat but if there are better options i am ready...

the dr had suggested stribild prior to the archive test... not sure if that has changed now or not...

[Jim Allen]

Well, Stribild might not be a great choice now given the resistance profile, but I would wait and see what options are presented and ask for some time to mull it over.

[harleymc]

There's resistance mutations and there's resistance to a medication. They are not the same thing.

Many mutations cause a partial resistance without rendering a medication ineffective.

I was in a similar situation to you in 96/97.

I started on raltegravir with a couple of other meds that I had partial resistance to.  That combo lasted me many years until switched up for lesser side effects


Don't panic about that word resistance, it's in that category of 'what if'.

[Buck746]

that is what i am counting on harleymc...

a bit gun shy as dr's have made bad choices on my behalf in the past...i had to pretty much beg to be put on my current regimen which has been highly successful for close to 15 years...just so tired of twice daily dosing and the myriad of sides and none pleasant...hopefully the dr will be able to discern between the two...

also the mutations are the same for the whole class..so either they share everything in common or it is just an across the board prediction..

i am also counting on the dr to have additional info and resources i am not privy too...one would hope...