Your Truvada / Pifeltro Experience?

[blanco]

Hi guys,

I was recently diagnosed with HIV. I contracted the virus about a year ago and learned of my diagnosis three months ago. Coming to terms with this disease hasn't been easy, but discovering that first-line HIV drugs are safe, effective, and generally lack serious side effects was truly encouraging and reassuring.

My initial blood test results showed a CD4 count of 612 and approximately 50,000 copies of the virus before I started treatment. My doctor prescribed Biktarvy a month ago, which I was pleased with since it's a highly regarded medication. However, a few weeks into the treatment, my HIV mutation test results came in. As it turns out, I am fortunate enough to possess a rare transmitted drug-resistant mutation to integrase inhibitors.

My doctor switched me to generic Truvada and Pifeltro instead of Biktarvy. As these drugs are considered second-line treatments, I'm now worried about potential side effects, the effectiveness of these drugs, and the possibility of developing resistance to them. I've read that they have a lower resistance barrier than Biktarvy, which adds to my concern.

I have a few questions:

• Does it take longer to become undetectable on second-line drugs like Truvada (emtricitabine, tenofovir) and Pifeltro (doravirine) than on Biktarvy?
• Given that I have a strain of HIV resistant to integrase inhibitors, should I be worried about acquiring resistance to Truvada and Pifeltro faster than other people?
• How detrimental is it to be resistant to integrase inhibitors right from the start? If I need to switch from Truvada and Pifeltro or become resistant to them, are there any good treatment options left for me?

Thank you so much in advance for your responses. If it weren't for the community and the opportunity to read about other people's experiences, I would feel much more insecure.

[leatherman]

Hello and welcome

My doctor switched me to generic Truvada and Pifeltro instead of Biktarvy. As these drugs are considered second-line treatments, I'm now worried about potential side effects, the effectiveness of these drugs, and the possibility of developing resistance to them. I've read that they have a lower resistance barrier than Biktarvy, which adds to my concern.

Don't put too much emphasis on the words "second line".

Current World Health Organization recommended standard first-line antiretroviral therapy for adults and adolescents consists of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus a nonnucleoside reverse transcriptase inhibitor or an integrase inhibitor. Fixed-dose combinations and once-daily regimens are preferred. Second-line antiretroviral therapy in adults consist of two NRTIs plus a ritonavir-boosted protease inhibitor.

https://www.unaids.org/en/topic/treatment

It's generally better practice to try to put patients on single pill regimens. It makes for better adherence when patients only have one pill at one time of day to remember.

Second line doesn't mean less effective or more side effects. These meds are just less used; but still used effectively especially for patients who have resistance factors or to reduce negative side effects from other HIV meds.

Resistance only happens when a patient haphazardly takes their daily meds. (like 2 days on, 4 off, 3 on...). When taken improperly, HIV can become resistant to meds when the med level in the patient gets too low. If you take your daily meds every day, you could stay on your regimen indefinitely. There are many people living with HIV still taking med regimens from the early 2000s because they have been effective and haven't caused those patients any negative side effects. In the future when newer meds might come to market, you might only want to change med regimens simply to lower your costs or reduce the pill burden (how many pills you would have to take in one day).

To sum up, "second line" doesn't mean less effective but mainly just less prescribed, and resistance only happens if you super screw up taking your meds daily.

Hopefully I answered some of your questions and gave you more peace of mind about your meds.

[harleymc]

I was on Truvada for many years. It treated me well.

[harleymc]

Just another note on 'second line'.

Second line doesn't mean or suggest second best.

 Often what the first line treatment is based on what works for 95% of the population, what is available in that part of the world, dosing ease, and costs for insurance providers.
So in your case 1st line was a one pill regime, 2nd line takes into account the resistance profile, and 2 pill rather than 1 pill dosing.

Nothing to do with second best, it's better for you

[BubbaPat]

I've been taking Truvada for years.  I've read up on the side effects and I've been living with them before I was on Truvada so I can't really blame it.
I just hate the fact that it's the size of a HORSE pill and Yes... I have a gag reflex when it comes to pills.

Bubba hugs.

[Nick_]

I am on Delstrigo which is basically Pifeltro and Truvada in a single pill.
It works fantastic for me - no adverse effects whatsoever. However, following a DEXA scan, I recently found that I have osteopenia in the hip joints and osteoporosis on the back (it’s been for quite a while, not related to Truvada). Now considering switching to Dovato.
Bottom line, Pifeltro+Truvada (or Delstrigo) is an excellent combination. Monitor your kidneys and bones and get regular and adequate supplementation with Vit D+Vit K2 and regular impact exercises for healthy bones.
Blessings!