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P.I. versus NNRTI
      #174463 - 02/10/06 05:57 AM

I am hearing a lot of good things about the Truvada + Reyataz + Norvir combo.
I am just about to commence my first line regimen, and wanted to enquire as to what anybody else thought of this combo?
I am starting therapy with a relatively high viral load / low CD4 count, and wanted to know if anyone else started treatment with this P.I. in my set of circumstances?
Also, does anyone feel that it is better to start with a P.I. in this instance rather than an NNRTI? I hear that the newer P.I.'s are a lot easier to tolerate these days - is that correct?

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Re: P.I. versus NNRTI new
      #175466 - 02/16/06 09:22 PM

Truvada, Norvir, and Reyataz are a very effective combination. Sustiva and Truvada are also quite effective. Here's a few advantages/disadvantages of each:

- The Reyataz combo in some people may cause a yellowing of the eyes due to interference with the hepatic function (liver). Note: Although this is a known side effect, it affects only a small's just something to watch for.

- Norvir must be refrigerated if stored for more than 30 days OR if it's stored at a temperate of more than the mid 70's fahrenheit. If your pharmaceutical insurance plan uses mail order, this may impact you since 90 day supplies are usually standard in mail order situations.

- P.I.'s have shown a little more resilience in not allowing viral mutations when doses are missed or taken late.....on the other hand, another theory says use the NNRTI's (Sustiva) until/if a resistance develops. That way you preserve the remaining classes of drugs for a later date.

- Sustiva can cause some vivid dreams in some people. This usually disappears or at least dissipates within the first month (usually the first few weeks).

- Sustiva and Truvada have extremely long half lives which means even if you take the medications a few hours late, the drugs have not dropped below therapeutic levels. Just be sure not to completely miss a dose...then the long half life actually works against you (it extends the period of time when the medication levels are waivering at the brink of non-therapeutic levels...which can sometimes lead to development of resistance).

- Sustiva and Truvada are likely to be available late in 2006 in a combination pill which will make a single pill taken once daily a reality for the first time.

- Both regimens are taken only once per day...nice for adherence and convenience.

- Reyataz requires an acidic environment in order to be absorbed no antacids are allowed within about an hour of taking the Reyataz. Prilosec is a permanent no-no since Prilosec reduces acid levels 24 hours/day.

- Sustiva levels can become elevated if taken at the same time as a high fat meal (not harmful...just increases the likelihood of the vivid dreams side effect).

- Both Sustiva and Truvada are non-thymidine based. Non-thymydine based drugs have not been associated with lipoatrophy or lipodystrophy, so it's unlikely that this combination will affect your bodily appearance.

- Although P.I.'s are the class of meds most closely associated with lipodystrophy, Reyataz has been one of the P.I.'s which has been shown to be least likely to induce you'll probably be OK appearance wise on either regimen.

- Consider your pharmaceutical insurance plan and look at the co-pays. If your plan is priced per medication, Reyataz/Truvada/Norvir would be three co-pays vs. two for Sustiva/Truvada (and may drop to one co-pay later this year once the new combo. pill is approved).

- If you are prone to long bouts of depression, Sustiva may not be a good choice for you (particularly in the first month).

Of course, all of this assumes that you have had a gnome type test done to ensure that you have no predicted resistances to particular medications.

Assuming that you have no resistances, ultimately both are very effective and can be taken indefinitely (years and years) provided you adhere to the treatment plan. I can't stress how important adherence is. Never missing a dose and taking them near to the same time every day is your first line of defense against developing a resistance.

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Re: P.I. versus NNRTI new
      #175467 - 02/16/06 09:24 PM

Oh...and regarding your question about high viral load and low CD4's....both regimens I highlighted are equally effective at bringing your VL to undetectable levels and allowing your T-cells to rise.

I'm on Sustiva and Truvada...I started a little over a year ago with only 142 T-cells, and I'm now at 614!

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Re: P.I. versus NNRTI new
      #176055 - 02/20/06 06:24 PM

i also responded very well to Sustiva & Truvada. my VL dropped to undetectable (from 86,000) in 4 weeks (10/3/05 - 10/31/05), but my CD4 only increased from 280 to 330. my most recent labs 1/16/06 i'm still untetectable BUT, my CD4 jumped to 651, my % is also pretty darn good @ 38%. i do have some trouble with my stomach getting upset depending on what i eat before/after i take the sustiva, but i just try to avoid those foods & everything is ok.

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