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Author Topic: Switching meds?  (Read 3105 times)

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Offline FiercenBed

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  • Posts: 183
Switching meds?
« on: November 18, 2006, 11:07:27 AM »
im @ cd4 347 28.9 and vl 489 truvada & kaletra since july. doc finally had the balls to say ' the treatment is failing'. hez bn saying everything is 'fine' past couple months and not to worry. now he sez i should have definitely bn undetectable by now. he sez it is going to be hard to do a resistance test w/ the viral load so low. also if u stay on a failing treatment it increases the virus's ability to develop resistance for other drugs. I DO NOT WANT TO CHANGE MEDS! the 2 month acclamation period was total hell. u name the side effect and I had it to the point of suicidal. Im still having some side effects but i can deal w/ them. im gaining weight and feeling 'ok' day by day.

anyway....my question is if or moreinlikly when i change meds am i going to have to go through the acclimation period all over again? or now that my body is adjusted to meds will it be a minor change?

thanx for the input!

Offline gerry

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  • Joined AM Feb 2003
Re: Switching meds?
« Reply #1 on: November 18, 2006, 12:46:35 PM »
I would not necessarily say that your treatment is failing.  It may just be taking a bit longer to get you to undetectable.  You started with a VL of 150000 and went down to 5000 in 1 month which is a pretty good response.  Your current VL is still within reasonable range of a fairly good response after 4 months.  The DHHS guidelines define incomplete virologic response as VL staying above 400 after 24 weeks of treatment.  Your current numbers, if I am not mistaken, were obtained at around week 16 or 17.  So you are still within striking distance of complete response.  This is assuming of course that you had baseline resistance testing which showed no resistance to the current meds you are taking.

Here's the definition of treatment failure from the DHHS guidelines:

"Virologic Failure can be defined as incomplete or lack of HIV RNA response to antiretroviral therapy:

• Incomplete virologic response: This can be defined as repeated HIV RNA >400 copies/mL after 24 weeks or >50 copies/mL by 48 weeks in a treatment naïve patient initiating therapy. Baseline HIV RNA may impact the time course of response and some patients will take longer than others to suppress HIV RNA levels. The timing, pattern, and/or slope of HIV RNA decrease may predict ultimate virologic response. For example, most patients with an adequate virologic response at 24 weeks had at least a 1 log10 copies/mL HIV RNA decrease at 1-4 weeks after starting therapy.

• Virologic rebound: After virologic suppression, repeated detection of HIV RNA."

Offline newt

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  • the one and original newt
Re: Switching meds?
« Reply #2 on: November 18, 2006, 01:02:52 PM »

What Gerry said

Plus a viral load of near 500 is high enough to do a resistance test with the latest generation of test, if they can't find enough virus to make the test work then you's probably on your way to undetectable.

PI based combos take longer to suppress HIV to undetectable levels than NNRTI (Sustiva etc) combos.  Me, on a PI, but different one, took 8 months.  Viral load tests do not produce exact numbers, there's some margin of error, tis possible you are in fact (well) below 400 copies already (er, but also above...soz). Given your very good initial response I'd wait n see, at least til 24 weeks.

Adherence is important, and sharpening your timing if this is a bit wonky may get the extra few virons knocked off the count.

Plus if you's doing Kaletra 1 x day, doing it 2 x day may also help (cos it will even out the dose and avoid a possible but difficult to measure drop to an ineffective level at the end of each 24 hours).

- matt
« Last Edit: November 18, 2006, 01:05:53 PM by newt »
"The object is to be a well patient, not a good patient"

Offline FiercenBed

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  • Posts: 183
Re: Switching meds?
« Reply #3 on: November 22, 2006, 07:02:13 PM »
update....vl results today.......3,822

i guess we can deffinitly call that a vl failure. great way to start off the holiday

happy thanksgiving  :-[

Offline allopathicholistic

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Re: Switching meds?
« Reply #4 on: November 22, 2006, 07:05:30 PM »
update....vl results today.......3,822

i guess we can deffinitly call that a vl failure. great way to start off the holiday

happy thanksgiving  :-[

Fierce: Please tell us exactly what you were told so we can best help you. Be strong honey

Offline FiercenBed

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  • Posts: 183
Re: Switching meds?
« Reply #5 on: November 23, 2006, 10:08:56 AM »
the doc said last month when the vl came back @ 489 it was a sign of resistance and i should have definitely been undetectable by now. so we waited 30 days and did a vl on monday and it came back 3,822. i was like god dam how could it jump that much in 30 days? I NEVER MISSED A DOSE OF THE MEDS! $12, 000.00 worth of meds and this.  at the end of the day iv gota start all over again. of more concern is the doc statement of i dont why. the resistance test done when i started meds showed no signs of resistance. wants to do the resistance test thing again. i was so sick when i started the meds. i really dont know if i wanna go through all that again. im really demoralized! really sets up for a great holiday :'(

Offline blondbeauty

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Re: Switching meds?
« Reply #6 on: November 23, 2006, 01:08:07 PM »
Sorry to hear that. It is strange, anyway, that your resistance test didnīt show any resistance. I might be in your same situation and ignore it. I didnīt get a resistance test and I wont have another VL. count till the 3th of January.
Lest see what does your next resistance test show and keep us posted.
Try to enjoy your holidays.
The only member in these forums approved by WINBA: World International Nail and Beauty Association.
Epstein Barr +; CMV +; Toxoplasmosis +; HIV-1 +.
Counts when starting treatment:
V.L.:80.200 copies. CD4: 25%=503
Started Sustiva-Truvada 14/August/2006
Last V.L.count (Oct 2013): Undetectable
Last CD4 count (OCT 2013): 52%= 933

Offline gerry

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  • Joined AM Feb 2003
Re: Switching meds?
« Reply #7 on: November 23, 2006, 02:12:54 PM »
Unfortunately, that's one of the limitations of getting a baseline resistance test.  It is not always the case that if it doesn't show resistant strains that it doesn't exist.  It is possible to be infected with a resistant strain, get it archived, and through a series of replications while not on medications, the wild-type virus re-emerges, predominates, and pushes the resistant strains in the background to the point where they can't be detected by the genotype test (since the test needs the resistant strains to be present in at least 10% of the viral population to be detected in the test).  When the meds that the resistant virus is resistant to is reintroduced, it kills off the wild-type and susceptible strains and allows the resistant strains to multiply again.  It's good that your doc is on top of this and addressing it before you develop more resistance and cross resistance.  Running another genotype test that would help choose which meds to put you on next.  I realize how disappointing this has been because of all the effort you have put into it.  The timing sucks as well.  On the positive note, there are plenty of other meds to choose from and hopefully, perhaps the next one would not give you as much side effects.  I wish you luck and please keep us posted.


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