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Switching Meds
May 24, 2013

I am 58 years old was diagnosed in 1989. I recently went for a follow up, I told my doctor I was developing inflammation and he decided to switch my meds. I have been taking Isentress with Truvada for three years also taking Omeprazole for acid reflux, Sertraline for anxiety. My CD4 506 viral load undetected. Had treatment for Hep C in 2005 but relapsed, waiting on new drug for Hep C that is more tolerant. I started three weeks ago taking Axiron for low testosterone and been feeling great. I would like your opinion on switching from the meds I'm taking now to Strild. I read that this drug is only for first time users so why is he prescribing it to me? I feel that starting this drug can be more harmful for my liver what would you suggest? Can you suggest Meds that are less toxic for my age?

Response from Dr. Young

Hello and thanks for posting.

Congratulations on being a long-term survivor-- since you've done so well on your current Truvada/Isentress regimen, I would very carefully weigh the pros and cons of switching to Stribild. Both regimens are very similar with regard to potency and side effects (though there are slightly more GI side effects with Stribild). Stribild's clear advantage is that it's a single pill, once daily. The Truvada/Isentress regimen has none of the pesky drug-drug interactions that can be a problem for Stribild. Stribild also shouldn't be taken with antacids (but can be taken with omeprazole).

It's perfectly ok to use Stribild in your situation- though studied in treatment naive persons, that doesn't mean it can't be used in people like you who are have never had treatment failure (for virological or drug resistance reasons). With active hepatitis C, I would be mindful of possible liver toxicity of medications and liver function should be monitored, but the overall toxicity rate in Stribild studies was about 2%.

I'd add that given your age, low testosterone, HCV and HIV infections (bone disease risk factors), I'd want to know a lot more about the health of your bones. Low bone mineral density problems, including osteoporosis are quite common in the positive population. Screening tests for osteoporosis (called DEXA scans) are currently recommended for all people over the age of 50. If your bone density is low, there are a number of steps that can be taken to improve bone health.

I hope that's a helpful start. BY

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