Initiating treatment: what meds to take?

[conwaygay]

I was recently diagnosed with HIV, I'm 20 years old and otherwise healthy.  Yesterday I had my first appointment with a specialist and we went over my genotype results (for some reason this was ordered before we got my VL or CD4 count) and I have a completely nonresistant strain of the virus.  Basically, the doctor told me the four preferred treatment and is letting me decide which I want to take.  I'm trying to weigh pros and cons of each and see what is best for me.  I know atripla seems to be the most common.  Of these four, which would you recommend and why?

Atripla
Reyataz/Norvir/Truvada
Prezista/Norvir/Truvada
Isentress/Truvada

[ad2san]

Hello There,

welcome to the forum.

It is very good news that you have a non resistant strain of virus.
The 4 combos that ur doc lists are indeed some of most common one. Combos 1,2 and 3 are once a day. Combo 4 is to my knowledge twice a day.

As you have the choice, choose among the once a day combo.

Provided that you should already start a therapy, you should know that all of them listed here are potent therapies against HIV and have side effects. Also it is difficult to recommend one because everyone reacts differently. There are some trends though  that you'll find discussed in the forum ....

You should first discuss this with your doctor what option is best for you depending on your lifestyle (working shift, party a lot, etc) and other parameters (do you take some other drugs etc).

Don't be to scared by what you may read it ... a therapy is a personal experience.

Cheers

[leatherman]

all of them listed here are potent therapies against HIV and have side effects.

that's really not correct information.

Reading the package insert material for nearly any given HIV medication clearly shows that 90%-95% of the people taking these medications NEVER have any side effects - especially the long term side effects. Of course, with nearly any medication at all, a person might experience some mild gastro or nausea issues as their body acclimates to the new meds (and in the case of HIV, acclimates to the meds and to the lowering of the viral load). However many of those issues clear up quickly on their own or can be managed.

to say that all definitely HAVE side effects is just not true. to say that someone MIGHT experience some side effects, and mostly mild, is something else entirely.

You are correct though suggesting to look at the trends in these forums. I can't count the amount of times that people post lamenting and fearing the start of medications, who seem amazed 2-4 weeks later when the actual experience of taking meds turned out to be anti-climatic with no issues. I'll just never understand why people will think that they are going to be the ones in the 1%-5% that experience side effects when the odds are so against that. 

[Jmarksto]

Hey Conway;

First, welcome to the forums - you found a great place for good information and support.  Here are a few comments on my experience.

I was one of the guilty ones that Leatherman referred to - pretty concerned about side effects, which turned out to be a non-issue.  As you read the forums here, keep in mind that people are more likely to post if they have issues which is not representative of all that don't have issues and are not posting.

I am on Complera (or Eviplera, depending on where you are) which is the once a day, single tablet combination Emtricitabine/rilpivirine /tenofovir disoproxil fumarate.  I don't see that as one of your options.  The advantage to Complera for me was avoiding the potential psychological side effects of Atripla, the downside is that it requires a meal of at least 400 calories.

Again, welcome, and I wish you well through this process.
JM

[leatherman]

I was one of the guilty ones that Leatherman referred to - pretty concerned about side effects, which turned out to be a non-issue.  As you read the forums here, keep in mind that people are more likely to post if they have issues which is not representative of all that don't have issues and are not posting.

but it's newer stories like yours that go on to help the even newer members. 

sadly though it seems like an endless parade of newbies arriving scared of meds, turning into regular members dealing with their meds, talking to the newbies arriving scared of meds, each of our "success" stories can bolster someone else dealing with their fears and worries. Being positive is a scary thing (and with good reason!) and we've all been there and probably will be there again at some point. But even when you're in the dark part of the cycle, giving and getting support from each other is the good part of the cycle.

keep in mind that people are more likely to post if they have issues which is not representative of all that don't have issues and are not posting.

that's always a good point to point out. thanks!

[buginme2]

  Of these four, which would you recommend and why?

Atripla
Reyataz/Norvir/Truvada
Prezista/Norvir/Truvada
Isentress/Truvada

One thing that you should understand is that each of these medication combinations (as well as some others) are equally effective.  One of these is not superior to another.  I know when I started I wanted to make sure I was on "the best" or "most effective" medication that was available.  There is a reason that these are ALL listed as preferred options. 

Now with that said, there are reason why someone would choose one over the other. 

Starting with convenience, Atripla is one pill once a day.  Thats pretty easy to take and to remember.  (Complera and Stribild are also one pill once per day, they are just as effective as the four listed here, so if you want to take a one pill per day option and Atripla isnt for you one of these would work too). 

The PI combos (Prezista and Reyataz) are very effective are also taken just once per day (although instead of one pill, you will take 3 pills but you take them all at the same time just once a day, easy peasy).  An advantage of the PI's is that if for some reason you think you may have some adherence issues.  Say you have an issue that would prevent you from taking your medication daily.  A PI regimen would be the way to go.  People who suddenly stop taking their medication are much less likely to develop resistance issues if they are taking Reyataz, compared to say Atripla or Complera.

The Isentress/Truvada is also very effective, low or no side effects.  Isentress is taken twice a day (one pill in the AM and one in the PM), the Truvada you take once a day.  This combo is great at reducing a viral load very quickly and has been shown to continue working long term. 

So, the choice is yours.  As you can probably figure out most of the newer medications are being released as one pill per day options.  If it were me, I would probably go with the Stribild option.  My second choice would be Isentress/Truvada.  All the others would tie for 3rd or 4th.  Thats just my personal opinion (but thats what you were asking for, right?)

[Anqueetas]

I would recommended skipping Atripla for now until there is clear research about potential brain damage from Sustiva, one of its component.

FOr Protease Inhibiter, most people will go for Reyataz/norvir/Truvada. It is easier to your lipid level than other PI.

If twice daily dosage is not a problem for you Isentress/Truvada also have a good tract record in potency, low/no side effect, and possibly can boost your CD4 as well.

I agree with the above, you don't have Complera(Eviplera) as a choice?

[Miss Philicia]

FOr Protease Inhibiter, most people will go for Reyataz/norvir/Truvada. It is easier to your lipid level than other PI.

Can you provide a link that this is the case as opposed with Prezista?

[WindySkies]

Stribild is another option.  It's very similar to Complera in that is has to be taken with a meal, but there is no recommendation on the calorie count.

I started with Complera about a month ago and after my current bottle runs out I'm switching to Stribild.  I take my pill with breakfast and have a hard time getting to 400 calories.  I usually have an egg beaters omelet with low fat cheese, a whole wheat bagel, and non-fat cream cheese.  That gets me to just under 400 calories.  I had very high cholesterol hence the non-fat items.  Plus I am on a diet now and eating less then I did before getting diagnosed.  That amount of food actually over fills me, so switching to the Stribild will allow me to eat a more moderately sized meal.

You're young, keeping things as easy as possible will probably suit you best, so I would try to stay with the single pill, once a day treatments.  And as someone else mentioned, staying away from the mental effects of Atripla might benefit you as well.

With Complera I have had zero side effects.  I'm expecting the same results with the Stribild.

[Hideyoshi]

Atripla FTW


just what i think.

[Mrmojorisin]

 I am taking Prezista/Norvir/Truvada. The only side effect is a little diarrhea from time to time, but I also dealt with that before I started meds. There are 4 pills to take once a day (2 prezista and 1 each of Norvir and Truvada). I really like my combo because it works very well for me. Getting used to taking 4 pills a day was easier than I thought.

[conwaygay]

I actually decided to make a chart including the four i listed, in addition to Complera and Stribild.  I didn't list those because they aren't first line treatment, so even though they may be available through my health insurance at a potentially outrageous rate, they may not be available to me through my ADAP program (if admitted to the program)

The chart lists Viral Load (% <50 copies/mL) and CD4+ increases in 48 week phase 3 trials, as well as side effects and estimated cost without insurance.  I'll see if I can find a way to post it up here.

Right now these are my thoughts:
-Stribild is my first choice, but with it being new, I can't be sure that it's been added to the formulary.  Stribild seems to yield the best results without so many side effects.
-Atripla is a close second.  Yields great results, but is heavy with side effects.  I don't fear these side effects because they'll probably fade in a few weeks.  Also, lipoatrophy is very unlikely with Atripla.  Lipoatrophy is something I'm willing to suffer side effects to avoid since I'm already pretty thin.
-Complera is affordable and with a VL below 100,000 copies/mL, it is very effective.  With a VL above 100,000 copies/mL, Complera is still good, but not as effective in lowering VL and increasing CD+.  Because I'm just initiating treatment, it's very likely my VL is 100,000+.  Thus, I'm ruling this one out for now.  It may be a good choice for me later down the road.  The lack of adverse effects is nice.
-Reyataz and Prezista combos just don't appear as effective as Atripla and Stribild.  They look good, but not as good.  The side effects appear to manifest themselves a bit more physically than the combination pills.
-Isentress and Truvada appear pretty awesome but I'd have to take Isentress twice a day.  I'm pretty compliant, but I have to make sure I'd be able to comply because I can't skip meds.  This is also the most expensive combination at $2691.95/mo here in Arkansas without insurance (though i have insurance).

Thanks for all of your input!  Opinions are still delightfully welcome!

[LoboDog]

Just wanted to say kudos to your doc... My first specialist didn't allow me to choose. Plus he put me on Kaletra which is definitely one that I don't recommend.

Good luck to you...

[Miss Philicia]

-Reyataz and Prezista combos just don't appear as effective as Atripla and Stribild.  They look good, but not as good. 

Based on what? Care to elaborate?

[conwaygay]

Based on what? Care to elaborate?

At the end of a 48-week Phase 3 trial for Reyataz/Norvir/Truvada:
82% had VL <50 copies/mL
CD4+ count increased by 211 cells/mm³

At the end of a 48-week Phase 3 trial for Prezista/Norvir/Truvada:
84% had VL <50 copies/mL
CD4+ count increased by 137 cells/mm³

this is compared to Atripla and Stribild who have these results:

At the end of a 48-week Phase 3 trial for Atripla:
84% had VL <50 copies/mL
CD4+ count increased by 206 cells/mm³

At the end of a 48-week Phase 3 trial for Stribild (Quad):
88% had VL <50 copies/mL
CD4+ count increased by 239 cells/mm³

By this, I can tell that while Atripla decreases the amount of virus in the blood the same as Prezista, Atripla increases CD4+ count significantly compared to Prezista.

Reyataz average VL after 48 weeks is significantly lower than Stribild, though it raises CD4+ to a level comparable to Atripla.

But Stribild seems to be the big winner here.

[bocker3]

I take Atripla and Reyataz/Norvir (have some nuke resistance).

I know some folks can not tolerate the Sustiva in Atripla -- but most do quite well with it.  Other than a few crazy dreams, I had no problem.  Although, if I eat something high in fat prior to taking it, I still have pretty vivid dreams -- nothing scary, just very vivid.  So, while some will swear it is an evil drug, take those warnings with a grain of salt.  Of course, if you have a history of mental health concerns, it might make sense to steer clear of it.
They Reyataz has caused me no issues either -- other than a slightly elevated bilirubin level.  Some folks turn yellow, I never have.

It is good to research and educate yourself -- but also be careful of over reading results.  All the combos you have mentioned should do just fine with controlling your virus --- ONCE YOU NEED TO START. 

Welcome to the forums
Mike

[Anqueetas]

Can you provide a link that this is the case as opposed with Prezista?

http://www.hivandhepatitis.com/recent/2010/0406_2010_a.html

From the article, "Robert Murphy and fellow investigators with the SABAR Study Team aimed to determine whether the protease inhibitor atazanavir -- which is known to be more "lipid-friendly" than other drugs in its class -- would have a beneficial effect on arterial function and other metabolic and inflammatory risk factors for cardiovascular disease."

[Miss Philicia]

http://www.hivandhepatitis.com/recent/2010/0406_2010_a.html

From the article, "Robert Murphy and fellow investigators with the SABAR Study Team aimed to determine whether the protease inhibitor atazanavir -- which is known to be more "lipid-friendly" than other drugs in its class -- would have a beneficial effect on arterial function and other metabolic and inflammatory risk factors for cardiovascular disease."

Correct me if I'm wrong, but your link doesn't in any way compare it with Prezista, a drug that is much newer in the PI class than Reyataz. Everyone knows Kaletra sucks with lipids -- ancient news.

[Anqueetas]

Correct me if I'm wrong, but your link doesn't in any way compare it with Prezista, a drug that is much newer in the PI class than Reyataz. Everyone knows Kaletra sucks with lipids -- ancient news.

I was wrong, Thank you Miss Philicia for an update info.

[dale gribble]

Conway atripla is the best bet 1 of the best hiv meds in the market

but as far as I read many want to sleep around

POZ TO POZ IS FALSE CAN KILL REGARDLESS IF YOU'RE UNDECTABLE I SEEN A FRIEND ALMOST DIED FROM FALSE STATEMENTS
1 EXPERIANCE ISN'T TRUE TO ANOTHER

YOU CANNOT GO WHAT THEY SAY ON HERE HIV EFFECTS DIFFRENTLY
AND U THINK WON'T HURT , WILL HURT YOU THE DR WILL KNOW BEST

[dale gribble]

the capital letters is how serious I was
all hiv meds isn't made for every resistant strain
I was there when a friend almost died

[Miss Philicia]

but as far as I read many want to sleep around

POZ TO POZ IS FALSE CAN KILL REGARDLESS IF YOU'RE UNDECTABLE I SEEN A FRIEND ALMOST DIED FROM FALSE STATEMENTS
1 EXPERIANCE ISN'T TRUE TO ANOTHER

What the fuck are you attempting to say?

[Rev. Moon]

Conway atripla is the best bet 1 of the best hiv meds in the market

but as far as I read many want to sleep around

POZ TO POZ IS FALSE CAN KILL REGARDLESS IF YOU'RE UNDECTABLE I SEEN A FRIEND ALMOST DIED FROM FALSE STATEMENTS
1 EXPERIANCE ISN'T TRUE TO ANOTHER

YOU CANNOT GO WHAT THEY SAY ON HERE HIV EFFECTS DIFFRENTLY
AND U THINK WON'T HURT , WILL HURT YOU THE DR WILL KNOW BEST

the capital letters is how serious I was
all hiv meds isn't made for every resistant strain
I was there when a friend almost died

You can be as serious as you wanna be; that doesn't make you an authority when it comes to HIV.  You don't seem to have a clue about the topic that you're trying to address. 

This is one of those instances when I kindly suggest to think, do some research, learn a thing or two, and think again before posting rubbish like the one that you just shared with the world at large.

[bufguy]

I've been on Atripla since June 2008...started with CD4 511, Vl 47,000. Today: CD4 1250, Vl undetectable.
I had side effects for the first 2 weeks. Now I have none....I can even take it with food...no problems.
I have been 100% adherent and take it anywhere between 10PM and 2AM depending on when I go to bed.
Atripla has a very long half life so timing is somewhat forgiving.
In my opinion...the "gold standard"

[0608]

One vote for Truvada/Isentress!  I know Atripla is probably more "popular," but I didn't want the possibility (as small as it may be) of the "Atripla Rash," and the Sustiva component sounded potentially kind of intense.  I started Truvada & Isentress two months ago, and aside from a bit of bloating after meals and 3-4 days of my fingertips feelings pretty sensitive, it's been smooth sailing, knock on wood.

Oh, by the way, I found out that I am undetectable as of two weeks ago.  It felt like I came home with straight A+'s, LOL

[Fisher]

Started Atripla about a month ago. One negative side effect was difficulty falling asleep.  Seems mostly resolved. Do tend to fart a lot now :-).  Only had one vivid dream, but will try fatty foods before bed to have more! Doc said initial response was "terrific." So even though I may lose a little more sleep over it, I think I'll stick with it. 

-fisher

[conwaygay]

I'm pretty decided on Stribild, but am torn between Stribild and Atripla.

I'm finding a lot of people have experience with Atripla, but Stribild is new, so not many people have experience with it.

Anybody on Stribild?

Also, does anybody know the chances of either causing lipoatrophy?

[Miss Philicia]

Also, does anybody know the chances of either causing lipoatrophy?

The newer drugs have not been found to cause that issue. Drugs during the mid-90's did that.

[jkinatl2]

The newer drugs have not been found to cause that issue. Drugs during the mid-90's did that.

From what I have read recently I get the impression that Sustiva (and therefore Atripla) is also on it's way to becoming an obsolete drug.

[Miss Philicia]

From what I have read recently I get the impression that Sustiva (and therefore Atripla) is also on it's way to becoming an obsolete drug.

I don't doubt that, certainly once Dolutegravir is approved, as well as GS-7340.

I'm quite sure this will be my regimen in 18-24 months, or so.

[Fisher]

I've been on Atripla for a little over a month.  Supression of the virus, lowering of the viral load, has been, for me, "terrific."

They say you get vivid dreams. I've only had one so far. Hoping for many more!

Some minor loose stool issues.

The only significant issue I've had has been about falling alseep. For me, sometimes it takes 2 to 1/2 hours.  Once asleep, then waking up to go pee or whatever . . . no problem falling back to sleep. And my doc is hoping that this issue will resolve also.

Hope this info assists.