Stribild to Triumeq?
Aug 31, 2014
Dear Dr. Young. I wrote to you in June about my good results on Stribild. was exposed in Thailand in Feb 2013, only chance of exposure. Got very ill in March during seroconversion. Was tested for HIV, RPR, HEP, all Negative, thought I was in the clear. But checked again for HIV in September, POZ, VL 65500 CD 146, 9%, was put on Stribild Oct. UD in 4 weeks. CD4 239, 23% at 3 months, 6 months CD4 405, 27% doing great. I've always been healthy . Never smoked, very light drinker. No side effects with Stribild, but my lipids went up a bit, so my Doctor put me on a statin (pravastatin) 20 MG because of family history. My Kidneys and Liver readings are all fine. October will be one year on Stribild. But being 53, I was wondering if Triumeq would be a better choice, I know you have been involved with both. Thank you so much. Married, ex-military here in Fort Lauderdale. wife tested Negative.
Response from Dr. Young
Hello and nice to hear back from you.
Sounds like you're doing great on Stribild- undetectable viral load, sharp increase in your CD4 count well into the normal range. That your wife is negative is great news too; having that undetectable viral load is probably the single most powerful way of preventing HIV transmission.
At our mutual age, it's reasonable to ask about other health issues at this point- cardiovascular, kidney, liver and bone disease to name a few. Screening for these and many others are part of current recommendations for the primary care of people living with HIV.
Both Stribild and Triumeq are among the elite regimens recommended by the 2014 US treatment guidelines. There are a few key differences between Stribld and Triumeq - Stribild contains tenofovir, requires the pharmacokinetic booster (and consequent possible drug interactions) cobicistat; Triumeq contains abacavir and does not require boosting. Tenofovir's key toxicities are kidney and bone- screening your health for both of these is recommended. If you don't have risks, then the added risk of continuing on tenofovir is small. Abacavir's principle issue is the possibility of causing allergic reaction. A screening genetic test called HLA B5701 essentially eliminates this risk.
Also to consider is the fact that as we age, we all (poz and negs) loose kidney function and bone mineral density. Keeping these organs healthy makes a lot of sense, so knowing your baseline kidney and bone health also makes sense.
While these two future juggernauts of single-tablet HIV treatment have not yet been tested head to head, they are likely to perform very similarly. For people who are HLA B5701 negative, IMHO, Triumeq would get the nod, especially, if they were older, or had risks of kidney or bone problems.
In the end, what will likely tip the balance isn't the subtle differences in excellent regimens, but rather cost and how the pharmaceutical industry prices these drugs. To my knowledge, the price of Triumeq has not yet been released, nor the drug's copayment programs been set. Because 2 of the three components of Triumeq are currently available generically in the US, the price of the combo pill cannot or should not exceed the price of the 2 generics plus the price of dolutegravir (the third drug in the combo; sold as Tivicay). If so, Triumeq should be substantially less expensive than Stribild. I don't have a ton of confidence in the shareholders and CFO's of drug companies though; we should hear about the price of Triumeq very soon, so stay tuned.
Lastly, thanks to your service to our country.
Be well, BY
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