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Author Topic: 1st Line & 2nd Line Treatments?  (Read 996 times)

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Offline Loa111

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1st Line & 2nd Line Treatments?
« on: January 21, 2019, 05:39:21 am »
What are the differences between 1st Line & 2nd Line treatment? Why? What reasons etc?

Just curious, I see these terms 1st Line etc mentioned on here from time to time, and cannot figure out the meanings in relation to our particular health aliment.

Offline Jim Allen

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Re: 1st Line & 2nd Line Treatments?
« Reply #1 on: January 21, 2019, 07:13:16 am »
Hiya,

I'm sure someone can explain this better, i hope this gives an idea though.

- First line is in short the recommended treatment combinations for most people 
- Second line is the recommended combo's, if the first line is for whatever reason not an option.   

https://www.poz.com/basics/hiv-basics/hiv-treatment-recommendations

What is first line or recommended continues to change over the years, this as HIV medications are continuously evolving with newer versions that might be a better choice due to reduced risk of side effects, easier to take, more efficient dosage, better suppression, lesser resistance profile etc etc etc

Example; Atripla, which is a perfectly solid combo working highly well for some people was taken off the recommend first line treatment list. Reason mainly was the type of and relative higher levels of side effect experienced by some, compared other sometimes newer treatments available.

https://www.poz.com/article/treatment-guidelines-Atripla-27065-1809

Jim

p.s
There is a whole section on the Supporting Evidence and Rationale Used for the Panelís Recommendations BTW https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/11/what-to-start
HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Loa111

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Re: 1st Line & 2nd Line Treatments?
« Reply #2 on: January 21, 2019, 11:43:52 am »
Thanks Jim, good info. I'll read the links.

Offline Expat1

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Re: 1st Line & 2nd Line Treatments?
« Reply #3 on: January 21, 2019, 06:21:24 pm »
In Thailand the first line is 2nrtis and one nnrti.  So usually Something like generic Atripla.  Or GPOVIR-Z.

If someone becomes detectable and resistant to the first line, in Thailand the second line is AZT+3TC (If not used in first line) and ATV.

If someone becomes resistant to second line the third line is with DRV and ??? It requires a committee to approve.  Second line also requires approval.

Above is for Public government program. 

As you can see not as many options as in high income countries. 

Offline virgo313

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Re: 1st Line & 2nd Line Treatments?
« Reply #4 on: January 21, 2019, 11:10:44 pm »
Quite the same in Malaysia. Generic Atripla is what most of us get. It cost our government around USD100 per month to treat us. We don't pay anything.

If 1st line is not working, then we need to fork out between USD250-350 per month for 2nd line treatment.

Will i have a chance to taste Biktarvy? Currently, i can only dream of this med.  :)
Not complaining. Glad to be alive.  ;D
RVD Nov 2015. VL --> Log 5.32 HAART on 23/11/15
TDF+FTC+EFV / Chemo KS - 25/11/15 - 20/01/16.
CD4 - 4 (3/11/15) / VL - 225,000   ~ CD4 - 65 (7/03/16) / VL - UD
CD4 - 153 (8/09/16) / VL - UD (20) / CD4% -6%   ~   CD4 - 215 (11/03/17) / VL - No Result / CD4% -8%
CD4 - No Result (10/04/17) / VL - UD (20)   ~   CD4 - 455 (11/05/18) / VL - UD / CD4% -14%
CD4 + CD4% (18/10/18) - Dr not going to  do this anymore / VL - To test only yearly. This Sucks..!
CD4 - 472 (10/04/19) / VL - UD / CD4% - 42%

Offline Loa111

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Re: 1st Line & 2nd Line Treatments?
« Reply #5 on: January 30, 2019, 03:39:12 pm »
In Thailand the first line is 2nrtis and one nnrti.  So usually Something like generic Atripla.  Or GPOVIR-Z.

If someone becomes detectable and resistant to the first line, in Thailand the second line is AZT+3TC (If not used in first line) and ATV.

If someone becomes resistant to second line the third line is with DRV and ??? It requires a committee to approve.  Second line also requires approval.

Above is for Public government program. 

As you can see not as many options as in high income countries.

That's interested about Thailand Expat1. I lived over there for a good few years, and know how things are down over there. LOL re a committee deciding about 2nd or 3rd line treatment. I can visualise an official with mounds of paperwork, and a dozen rubber stamps lined up..you know how in Thailand officials love paperwork & stamping it & signing it every single page etc !  ::)

I've very happy I moved back West before I found out my Dx as paying for treatment in Thailand would have been a terrible difficult strain on my budget. Even though I legally worked out there, paid social security/insurance monthly & I had a blue medical card for the government hospitals....I would not have been able to use that to avail of treatment (I'm quite sure).

I hear their government treatment scheme, even though there's not much choice on the med combos, it does seem too do a good job.

Offline Expat1

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Re: 1st Line & 2nd Line Treatments?
« Reply #6 on: January 31, 2019, 04:36:26 pm »
You realize that the price of treatment in Thailand is a fraction of the price of treatment in the West.

The GPO-Vir option runs about 500 baht a month, the Generic Atrlipla version is about 1200 baht per month. 

The Second line version is around 6000 baht a month.

Third line is about 7000 baht a month.
 
If self paying at government hospitals or the Red Cross Clinic.

Private hospitals run 2 to 3 times as much.

I pay Pattaya Memorial 800 baht for a bottle of brand name Edurant (30 tablets). It costs around 31000 baht in the US for the exact same bottle of pills, made in the same factory, put it identical bottles.  (They come from Ireland according to my bottle.)

Glad I live in Thailand, so I dont have to pay extorsionist profits to Aids Profiteers who seem to think that they can price a molecule at what ever price they want irregardless of the actual cost to produce said molecule.

Offline Loa111

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Re: 1st Line & 2nd Line Treatments?
« Reply #7 on: February 01, 2019, 04:04:39 am »
I didnít realize a self paying farang could avail of such affordable prices for treatment, thatís good! Obviously the generic versions make this possible.

Yes I know Memorial hospital, though I used to go to the government hospital in Banglamung if sick. Stayed well away from those private hospitals, get ripped off there, usually often  same doctor works in gov hospital or their own very affordable private clinic ;)

Lucky in my country treatment is free which is great.

Offline Expat1

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Re: 1st Line & 2nd Line Treatments?
« Reply #8 on: February 01, 2019, 01:05:29 pm »
Actually the outpatient department of Pattaya Memorial has 5 regular doctors that work there full time. 

The hospital runs clinics using doctors pulled from the public sector for specialities.

Teevir is about 2700 baht, real Atripla is 3600baht a bottle at PMH.

The costs of meds and medical care in Private hospital is less that I would pay for copays, deductables, donut holes etc in the US. 
I pay between 100-250 a month for all health care needs, my insurance which I pay about $700 a year for covers non hiv issues, illnesses accidents, etc.

And I pay, I dont have to beg some drug company or government agency for welfare to cover the cost of my meds  which would be about $30,000 per year in the US.  Total profiteering!




Offline Expat1

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Re: 1st Line & 2nd Line Treatments?
« Reply #9 on: February 01, 2019, 01:13:56 pm »
It is difficult to access Banglamung for HIV treatment if Thai even if self paying.  (Partner Tried and was refered to Chonburi Hospital by them.) 

For a foreigner, I asked at the Pharmacy, and was told that they only have HIV meds for Thais.  (Really!)

In pattaya the best options are Dr. Phillip who runs a NGO.  (For both locals and foreigners.)  Pattaya Memorial if you can pay the above amounts.   

If unconcerned about costs Bangkok Pattaya has more meds, doctors etc and is about double the cost of Pattaya Memorial Hospital. 

Pattaya international has only a few medicines.

Pattaya City does not prescribe HIV meds and will refer you to Banglamung.  They can treat for other STDs there.  More cheaply than Pattaya Memorial. 

 


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