When do Med changes get offer?

[Loa111]

I've been wondering recently, and I suppose this depends greatly on what country & health system on is in....

Do ID Docs tend to suggest new medications with a view to changing ones treatment or is it more of a case of "if it is not broken don't fix it!" (unless something much better comes along).

I am not thinking of changing myself as what I take, Tivicay + Descoy, is working very well for me thankfully, and is still a fairly modern treatment.

However I was wondering about the question in general?

[Jim Allen]

Think it depends on your doctor and you.

Ultimately you are the pilot.

My own doctors do recommend newer treatments from time to time but when I ask why and based on what evidence the conversation ends rapidly.

[Loa111]

My own doctors do recommend newer treatments from time to time but when I ask why and based on what evidence the conversation ends rapidly.

Interesting Jim since we are both in the same country. I've never had a suggestion at all yet.

I did express several times concern with belly fat which I strong suspect is treatment related, however a med change was mentioned very lightly in passing once, but never followed up on. I didn't push it either as I think it meant a change to a slightly older treatment which might not have benefitted long term bone strength as much as my current treatment.

I will borrow your question "I ask why and based on what evidence the conversation ends rapidly." if a new treatment change is suggested. That's a good question to ask. 

[Jim Allen]

I didn't push it either as I think it meant a change to a slightly older treatment which might not have benefitted long term bone strength as much as my current treatment.

Hmm... I think you should have this conversation again. From this, I understand that you don't want to switch to something with TDF instead of TAF. That said, TDF is safe for many millions with the added benefit of weight control factors compared to TAF.

More importantly, older meds does not mean they are bad, and if you really want to switch, then prehaps asking about your options that don't have TDF or TAF would be one way to go. I'm a tad biased, though, as I would not accept TDF or TAF myself.

[leatherman]

"if it is not broken don't fix it!" (unless something much better comes along)

that's probably the best view quite frankly

reasons for changing medications could be cheaper costs, fewer pills, or more effective meds.

The catch today is that the most used combinations all work well for most people. This isn't like the old days when we waited for new meds, when resistance was easier to occur, when side effects were much worse. Today it's more like tweaking a treatment for the fewest negative side effects (which are rarely long term negative effects)

I was on my last regimen for 12 years and had no negative side effects. When I switched to a different doctor 6 yrs ago we re-evaluated and switched to a slightly different regimen. Still no negative side effects, and the cost was the same. The only things that changed were that I dropped from 3 to 2 pills, and my cd4s went from 350 to 550. Of course that didn't make me any "healthier" so it wasn't a dramatic change. In full disclosure, my cd4 could simply just be that high because of 30 years of meds as I've been on a slight increasing trend line for 15 yrs.

I know several people who are still taking Atripla with no issues and no reason to change. I think if you're not considering a change for the normal reasons (cheaper costs, fewer pills, or more effective meds) then there's probably no reason to change