HIV Treatment

[Texland]

What (if any) are the alternatives to Biktarvy? Dovato is not quite working for me.

[Jim Allen]

Hiya,

Prehaps you can clarify what is not working with Dovato for you?

[Texland]

Whoops, I intended this as a reply to the thread "Switching from Biktarvy to Dovato...?" Not sure how it ended up on its own.

I switched from Biktarvy to Dovato last April. My labs in August had a viral load of 57. The most recent done a few weeks ago were at 160. My new doctor doesn't like the trend or the fact that I was on 3TC many years ago. She suggested that I go back to Biktarvy. I did fine on it other than gaining 25 pounds after being on it for two months and a racing heartbeat at times. The new doctor says she sees patients gaining about 30 pounds when they start Biktarvy. I do not need to gain another 30 pounds, too much family history of diabetes and other things.

Can something be added to the Dovato or is there another drug regimen?

Before Biktarvy I was doing fine on Truvada and Tivicay. My doctor at the time was leading the Biktarvy study locally. I'm not sure if changing back to Truvada and Tivicay is an option.

[Jim Allen]

I split it as we should not be posting issues in other peoples threads.

Can something be added to the Dovato or is there another drug regimen?

If your going to add something ABC would be obvouise, that would make Triumeq (DTG,3TC, ABC)

I'm not sure if changing back to Truvada and Tivicay is an option.

Is something to discuss for sure. Prehaps Descovy (TAF) + DTG even. There are other options. https://www.poz.com/basics/hiv-basics/hiv-medications

[Jim Allen]

Personally, I would not be switching with the VL detected you mentioned yet though. But we all need to make that call for ourselves.

[Texland]

Personally, I would not be switching with the VL detected you mentioned yet though. But we all need to make that call for ourselves.

In our first (phone) meeting, the doctor did not like that I am on Dovato and had been on 3TC many years ago. She said there is too much chance of resistance.

A thread started by Buddhabear2138 spells out everything I worry about going back on Biktarvy.

https://forums.poz.com/index.php?topic=75140.0

[Jim Allen]

If you want to switch and don't want to take Biktarvy there are other options depending on your other medical needs etc. I would suggest looking into the list of the meds ahead of your next meeting with your doctor.

We all have different needs, for example, anything with TAF/TDF I would not touch with a bargepole. However, it works well for others.

[Texland]

The doctor just called. She recommends Descovy and Tivicay since I don't want to take the Biktarvy. She did not want to prescribe Abacavir because it's an older drug and it's possible i might have taken it in the past. To test what medications I might be resistant to requires a much higher viral load.

I've never had a doctor call the same day as when I left a message.

[gorka]

some new studies show that TAF also contributed to weight gain and TDF  does not. so not sure descovy would be good either.  i am in same boat as u gained ton of weit on biktarvy.   now on dovato but not loosing any exactly either. 

[Matths]

There is literature out there that besides the INSTI group (more the modern ones) lead to weight gain. Amongst other substance groups, TAF seems to be another culprit. Whether these drugs alone or only when you take them as a combo, ie bictegravir+TAF cause weight gain (amongst other factors) is unknown I think.

I for myself would try to avoid taking a combo that involves 2 drugs known for causing weight gain, ie Biktarvy or Tivicay+Descovy. I’m on Dovato and gained about 5 pounds over the past 2 years since I started taking it. Most of it during the first year and since then my weight is stable.

Sadly, I noticed that gaining weight is easy. Loosing it takes much more time and effort, and the pandemic didn’t help (except for serving as an excellent excuse not having tried harder). This entire issue on weight gain and its consequences is an emerging topic and certainly very important. In a different comment I posted a good review article on the topic. Best Matt

[Texland]

some new studies show that TAF also contributed to weight gain and TDF  does not. so not sure descovy would be good either.  i am in same boat as u gained ton of weit on biktarvy.   now on dovato but not loosing any exactly either.

Hey Matt,
The doctor said Descovy would not cause the weight gain that Biktarvy causes. My first go-round with Biktarvy really packed on the pounds. In the more than four years since starting it, minus one on Dovato, I've only lost five pounds. Through the pandemic so far I've managed to stay about the same weight.

Thanks for the article link on the other post, I may share it with my doctor.

[Matths]

Hi Texland, when I read your messages I was thinking what I would do if I was in your shoes.

I think that Tivicay+Descovy is a great combo (with the one caveat that TAF which is one part of Descovy was also linked to weight gain). Therefore, you may have potentially 2 drugs in your combo (dolutegravir and TAF) which have been linked to weight gain.

You could discuss as alternative to Descovy the good “old” Truvada (which has TDF and was not linked to weight gain but other potential issues). However, your doc knows best your entire treatment history, your current and past blood work, family history etc etc. The decision you both have to make certainly must take into account many factors but I think you have options available to you that ensure you return back to UD and facilitate weight control. Good luck and keep us posted, best Matt

[gorka]

i would think Tivicay+Descovy  would result in same weight gain profile like biktarvy.  I am trying to stay away from Descovy. 

[Loa111]

I'm on Tivicay+Descovy almost 3 years and it certainly has put a bit of extra weight on me about 5kgs a lot of it around my belly, I got a gut which I never had before.  At Dx, I had to gain weight back as part of recovery as I was quite ill. However these days now things are well back to normal the extra weight is there.

I train a lot, running a few times a week, weights when gyms are open, martial arts, make sure I walk everywhere too, and I eat fairly good. Yes the weight & gut just refuse to shift, so at this stage I'm pointing my finger at Tivicay+Descovy as the cause. It's a bit annoying but not the end of the world.

Hopefully you'll find a solution to your weight gain problem.

[Jim Allen]

@All

Weight gain is a complex issue, and evidence is there are multiple factors to this. When starting treatment for the first time, switching, VL, HIV itself. ageing etc., etc.

If you are posting about or mentioning studies or evidence, please include at least a basic link to it and keep in mind this is the OP thread!

Jim.

TDF/TAF

https://www.poz.com/article/study-sheds-light-weight-gain-switching-new-tenofovir
“These data suggest that differences in weight gain between TAF and TDF are likely driven by removal of TDF-associated weight suppression,”

https://www.poz.com/basics/hiv-basics/taf-versus-tdf-difference

https://www.aidsmap.com/news/jul-2020/rapid-weight-gain-after-switching-taf-regardless-other-hiv-drugs-taken
people who switched to TAF experienced an early and rapid weight gain in the nine months after switching, followed by a slowing or plateauing of weight gain.

Starting treatment/HIV
https://www.poz.com/article/starting-hiv-treatment-associated-weight-gain

https://www.poz.com/article/hiv-may-lead-big-belly

https://www.poz.com/article/starting-hiv-treatment-women-gain-weight-men

https://www.poz.com/article/weight-gain-immune-activation-may-linked-people-hiv

https://www.aidsmap.com/news/mar-2015/does-hiv-make-you-fat-study-connects-viral-load-fat-gains

Integrase Inhibitors:

https://www.poz.com/article/dolutegravir-plus-taf-associated-steepest-weight-gain

Switching to Integrase Inhibitors Not Tied to Gain in “Bad Fat”
https://www.poz.com/article/switching-integrase-inhibitors-tied-gain-bad-fat

https://www.poz.com/article/integrase-inhibitors-may-tied-weight-gain

https://www.poz.com/article/normal-weight-gain-switch-integrase-inhibitors