|To Quit or Not to Quit (meds)
Aug 10, 2000
Thanks for a truly invaluable forum!
I was diagnosed over two years ago in May. I was caught right in the middle of seroconverting and became part of a seroconversion study group. My VL load at that time was extraordinarily high, but I started triple therapy immediately (Crix,Epivir & Zerit)and went to undetectable in about 6 weeks. My Doctor went the Dr. Ho route, hitting hard and hitting early. I have been undetectable with a high T count (average 750)ever since. I have been diligent since starting therapy. Since beginning, I have missed a total of three doses only. I did, however, switch the Crix for Viracept after about 6 months because of toxicity. I should also mention that I have also been taking Immodium on a daily basis since switching to Viracept. My energy has been lowered since the meds started. I have returned to the Gym, but am not quite the guy I use to be.
Here's the question. Over the last year I have noticed many of the classic PI side effects creeping up, loss of fat in the face and butt, shrinking limbs, slight swelling in the abdomen and heightened cholesterol (the loss of hair stopped after stopping the Crix). I want to try one of two alternatives, either stop meds entirely and save them for when I really need them or switch to a non-PI therapy. Has there been ample study on controlled "holidays" yet? Will I be cooking my goose on my current therapy if I stop it now? Is there conclusive evidence that non-PI therapy is effective in keeping VL undetectable over a long period of time? I know that I need a change, but I need it to be an educated and informed decision. I accept that PI side effects exist, but if I can postpone them, I would like to do so. The PI "look" has become mainstream and easily recognized, and in my career it would be detrimental.
If you know of a study group in LA that has been successful in "controlled holidays", I would certainly appreciate the info. I gotta change something soon.
| Response from Dr. Henry
Good question. Unfortunately, we lack the long-term data that would help us make the most useful recommendations with any confidence. Switching to a simpler regimen like AZT + 3TC + abacavir (2 pills two times a day) often will result in improved lipids and possible body shape. The ACTG is planning some switch studies and Glaxo is running a national study comparing continuing the PI to an abacavir switch. Stopping the meds for now often will result in improved symptoms but a rebound in HIV levels and a fall in CD4 count. For many persons that trade-off is a good one as long as they are followed carefully. The ACTG is planning on a study wherein persons stop their meds for a prolonged period of time and restart on the basis of their T cell count. They then will get pulses with HIV meds until the T cells have rebounded and then stop the meds again. That study might be opening in the fall. I would contact the ACTG site at USC or UCLA to ask about study options as well as discuss with your HIV doc. The goal is to live long and prosper (thank you Pablo Tebas!). Keith Henry, M.D.
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