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Author Topic: Dosage adjustments - where are the studies for that?  (Read 3046 times)

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  • Guest
Dosage adjustments - where are the studies for that?
« on: November 18, 2006, 12:42:29 AM »
Why hasn't there been any studies on the dosage needed for treatment naive vs. long term use clients (w/viral loads undetectable)????  I feel that we get bombarded with high doses of medication as if we were treatment naive and we don't ask any questions about dosage adjustment.  I personally don't believe that an individual with an undetectable viral load and high T-cell count needs as much medication as someone who has a high viral load and low T-cell count.  Any researchers or M.D.s out there can answer that for me?


Offline newt

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Re: Dosage adjustments - where are the studies for that?
« Reply #1 on: November 19, 2006, 07:10:41 AM »
There aren't any really.  Some studies show promising results using fewer drugs after an initial blast of treatment, eg just using a strong PI - the reuslts are promising, seems to work for many, but not everyone. We need more studies on how many / how much drugs for long-term therapy.

- matt
"The object is to be a well patient, not a good patient"

Offline suzieque

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Re: Dosage adjustments - where are the studies for that?
« Reply #2 on: November 19, 2006, 08:18:45 AM »
 Wondering about this myself, due to change meds AGAIN due to lipoatrophy ( even though I am on supposedly lipo friendly combo of Reyataz, ritonovir booster, epivir and tenofovir). My doctor was mentioning some people doing well with just Kaletra, anyone have any thoughts, experience? Thanks :)

Offline newt

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Re: Dosage adjustments - where are the studies for that?
« Reply #3 on: November 19, 2006, 08:59:31 AM »

In terms of suppressing the virus, all the newer PIs are very good, Reyataz, Kaletra etc. Reyataz seems more friendly to blood fats (lipids).  Generally more friendly than Kaletra. Nothing much is said either way about Reyataz and fat loss in the face etc in the literature.  While nothing said may = no effect, for you this may not be the case eh?


Fat loss, not really to do with PIs, so switching to Kaletra ain't likely to help.  Fat loss is most likely down to the nukes, in your case epivir and tenofovir.  If you have been on an AZT to d4T based combo in the recent past (like 2 years), fat loss can take a long time to stop / recover.  Sometimes it just goes on and on after a switch, eg, to tenofovir.  While not dramatic, I do notice, if I don't drink a beer of an evening n keep a decent amount of fat in my diet, the fat drops off me, well nice to look ripped but do like a comfy bum to sit on etc.  This is on tenofovir / FTC, nearly the same as you. 


All drugs affect cell metabolism and different people respond differently to different combos.  While AZT and d4T (and by extension for some people perhaps other nukes) are bad for fat loss, PIs and NNRTIs may have a role.  We don't really know.  Since individual genetics makes a difference, a switch may be a help.


Treatment or no, it's an effect of the damn virus.


1. Abacavir instead of tenofovir (resistance etc permitting).

2. Just using one nuke. Non-standard this but 3TC / FTC / abacavir / tenofovir alone may be enough with a decent PI for maintenance.

3. FTC instead of 3TC - it seems a bit kinder to the metabolism than 3TC, otherwise basically the same.

4. PI monotherapy. Kinda off-piste. Results from preliminary studies are promising, esp. for the people who's been on treatment for some time and have undetectable viral loads. But, experimental, strictly speaking.

5. Supplements: ALA and L-acetyl carnitine.  Protective, unproven but good end user write ups.

- matt
"The object is to be a well patient, not a good patient"

Offline suzieque

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Re: Dosage adjustments - where are the studies for that?
« Reply #4 on: November 19, 2006, 10:37:10 AM »
   Dear Matt,
          Thanks for your reply :) Unfortunately I am sensitive to abacavir, that was our first thought for a change. Doc seems to think that the lipoatrophy is being caused by the NRTI's, not PI's, tenofovir being the only one he has seen it with. Don't know about the Epivir ( only one I have had in every combo). Have had lots of lipoatrophy, funny enough in different places depending on the meds. First butt and temples, switched, fat came back, then face all over, took a treatment interruption, fat came back, then lost it on hands and feet, took ANOTHER treatment interruption all the fat came back! Kind of confirms for me that it has everything to do with the meds, and not the virus itself, at least in my case. Back on and it's going again!! Quite a roller coaster! Will see what he comes up with tomorrow!

Offline yowsaa

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Re: Dosage adjustments - where are the studies for that?
« Reply #5 on: November 26, 2006, 04:15:18 AM »
Yo Matt,
What is that # 5 you speak of, a supplement or another pill?

Hey Suzie,
How'd you make out with your Doc. Make a switch or still mulling it over ?


  • Guest
Re: Dosage adjustments - where are the studies for that?
« Reply #6 on: March 03, 2007, 04:56:48 PM »
Hey Matt,
Can you give me a little more info on the ALA and the other supplements?


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