Re: Recent Diagnosis

[Guest guest]

Either of two drug combinations are the standard for beginning therapy in Thailand:

1.) GPO-VIR-S30, which contains d4T 30 mg, 3TC 150 mg and Nevirapine 200 mg, or;

2.) the combination of Stocrin [sustiva in US] with Combavir (300 mg AZT with 150 mg 3TC).

Studies in Thailand have proven both to be equally effective. Stocrin has demonstrated some undesirable effects on foetuses, such as an enlarged tongue.

In the U.S. there is increasing concern over the long-term side-effects of AZT and d4T (both altered forms of the amino acid Thymidine). These irreversible side-effects include wasting and fatigue.

As for side-effects which manifest quickly, GPO-VIR-S30 should be discontinued at the first sign of numbness or tingling in the hands or feet (caused by d4T). If the drug is withdrawn quickly, these problems are usually reversible within a month. If the therapy is continued, these problems will progress and expand to irreversible pain and numbness.

In the U.S. the AZT or d4T in both of these combinations would likely be replaced with tenofovir (Viread) which I believe is also now price subsidized in Thailand. This is because Tenofovir has fewer side-effects and better long term durability in terms of viral resistance.

Everywhere in the world there is a recent tendency for drug makers to market "convenient" combinations of drugs they own. These combination tablets frequently include older less desirable drugs rather than newer and better drugs owned by a different company. For this reason I would rather take each drug seperately. In addition, if you develop a drug related problem it is impossible to determine which drug is the cause when they are all package together in one pill.

3.) Kivexa [Epizicom in the U.S.], which is a combination of Ziagen (abacavir) and epivir (3TC), when combined with Stocrin [sustiva] is also an effective combination.

All three of these combinations would be greatly enhanced by the addition of Kaltera, which is price subsidized in Thailand to approximately $500 per year (compared with $8,000 in the U.S.). If I were beginning treatment, I would combine the Kaletra with one of these three combinations (substituting tenofovir for either the AZT or d4T). After my viral load was undetectable, I would consider dropping the Kaletra to see if the remaining combination was sufficient to maintain an undetectable viral load. I suspect there is a reason your Doctor wanted to add the Kaletra.

There is a risk to the two of you having unprotected sex. This is true whether you are taking the same or different drug combinations. It is a risk I take, but there is still a risk.

Likewise, having a child involves many risks. Although antiviral drugs reduce the risk of having a child born with HIV, it is not a risk I would take. In addition, you will find that living with HIV imposes many burdens, financial, time and energy. Adding the responsibilities of a child should be carefully considered.

>> Hi,> > My wife has been recently diagnosed. Her CD4 is around 400 and liver> function is ok (SGOT 26, SGPT 15). Her body weight is 40Kg (normal) and she> is healthy. She contracted the virus from me before we were married and way> before I knew I was +ve. We have been together for 4 years and I nearly died> from PCP in March this year and commenced treatment with CD4 of 11.> > The doctor in Thailand eventually precribed a 3way medication called GPO-Vir> S30 which contains d4t 200Mg, 3TC 150Mg, NVP 30mg after some discussion.> There are two pills taken per day (one in ther morning and one at night). As> I understand it this is a 2 nuke and 1 non-nuke regimen that should be as> effective as anything else around the place for treatment naive patients. I> was surprised when he suggested that she also add Kaletra to the regimen.> > I told him that I thought it was overkill and that I didn't want to risk> exposing her to too many drugs at once and that 3way HAART with either> Combivir and Strocrin or the regimen desribed above would probably be> adequate and preserve treatment options. He backed off on the Kaletra. I> didnt want to go with the Combivir/Stocrin regimen because if we want to> have a child then she would have to change meds and remove the stocrin.> > A couple of questions:> > 1. Is the regimen he subscribed adequate for a treatment naive> patient?> 2. Is adding Kaletra to the 2 nuke, 1 non-nuke regimen a good idea for> treament naive patients?> 3. Are there any treatment issues with us being on different regimens> and us having unprotected sex together (as one normally would when married)?> - I have been 100% compliant and I am on Ziagen 2x300Mg, Epivir> 2x150Mg, Stocrin 1x600Mg> - My viral load went undetectable in July and my CD4 count is> now 100> - She will start her meds next week> > Does anyone have any better suggestions for a first regimen based on what I> hav outlined above?> > Rgds> >

[Guest guest]

My wife has been recently diagnosed. Her CD4 is around 400 and liverfunction is ok (SGOT 26, SGPT 15). Her body weight is 40Kg (normal) and sheis healthy. She contracted the virus from me before we were married and waybefore I knew I was +ve. We have been together for 4 years and I nearly diedfrom PCP in March this year and commenced treatment with CD4 of 11.The doctor in Thailand eventually precribed a 3way medication called GPO-VirS30 which contains d4t 200Mg, 3TC 150Mg, NVP 30mg after some discussion.There are two pills taken per day (one in ther morning and one at night). AsI understand it this is a 2 nuke and 1 non-nuke regimen that should be aseffective as anything else around the place for treatment naive patients. Iwas surprised when he suggested that she also add Kaletra to the regimen.I told him that I thought it was overkill and that I didn't want to riskexposing her to too many drugs at once and that 3way HAART with eitherCombivir and Strocrin or the regimen desribed above would probably beadequate and preserve treatment options. He backed off on the Kaletra. Ididnt want to go with the Combivir/Stocrin regimen because if we want tohave a child then she would have to change meds and remove the stocrin.A couple of questions:1. Is the regimen he subscribed adequate for a treatment naivepatient?Yes.  The combination of D4T, 3TC, and nevarapine should be a good combination, in terms of viral control.   I would caution you that D4T is very strongly associated with the complication of lipoatrophy.   If another nucleoside such as AZT is available, I would personally prefer that.    It isn't clear from your note if you live full time in Thailand, and I'm not familiar with all of the options there.  Tenofovir, if available, would be an even better choice!2. Is adding Kaletra to the 2 nuke, 1 non-nuke regimen a good idea fortreament naive patients?That would be a very strong treatment.  I'm not sure if there are individual issues in your wife's care that are making the doctor consider aggressive therapy.3. Are there any treatment issues with us being on different regimensand us having unprotected sex together (as one normally would when married)?- I have been 100% compliant and I am on Ziagen 2x300Mg, Epivir2x150Mg, Stocrin 1x600Mg- My viral load went undetectable in July and my CD4 count isnow 100- She will start her meds next weekThis is a very personal question.  While some might argue for safer sex practices all the time, if you are both undetectable, without resistance, I don't think I would argue against the two of you making whatever decision is easiest for the two of you to live with.Does anyone have any better suggestions for a first regimen based on what Ihav outlined above?I persoanlly like Stocrin better than nevaripine, but if you are considering a pregancy, NVP is the better choice.As a general point, I would stress that your case, once again, should remind everyone that you do not want to find out that you have HIV by getting PCP.  I hope you will encourage your friends to get tested now.  PCP kills, and even if you should survive, the convalescence is long and hard. Barrowpozbod@...

[Guest guest]

My wife has been recently diagnosed. Her CD4 is around 400 and liverfunction is ok (SGOT 26, SGPT 15). Her body weight is 40Kg (normal) and sheis healthy. She contracted the virus from me before we were married and waybefore I knew I was +ve. We have been together for 4 years and I nearly diedfrom PCP in March this year and commenced treatment with CD4 of 11.The doctor in Thailand eventually precribed a 3way medication called GPO-VirS30 which contains d4t 200Mg, 3TC 150Mg, NVP 30mg after some discussion.There are two pills taken per day (one in ther morning and one at night). AsI understand it this is a 2 nuke and 1 non-nuke regimen that should be aseffective as anything else around the place for treatment naive patients. Iwas surprised when he suggested that she also add Kaletra to the regimen.I told him that I thought it was overkill and that I didn't want to riskexposing her to too many drugs at once and that 3way HAART with eitherCombivir and Strocrin or the regimen desribed above would probably beadequate and preserve treatment options. He backed off on the Kaletra. Ididnt want to go with the Combivir/Stocrin regimen because if we want tohave a child then she would have to change meds and remove the stocrin.A couple of questions:1. Is the regimen he subscribed adequate for a treatment naivepatient?Yes.  The combination of D4T, 3TC, and nevarapine should be a good combination, in terms of viral control.   I would caution you that D4T is very strongly associated with the complication of lipoatrophy.   If another nucleoside such as AZT is available, I would personally prefer that.    It isn't clear from your note if you live full time in Thailand, and I'm not familiar with all of the options there.  Tenofovir, if available, would be an even better choice!2. Is adding Kaletra to the 2 nuke, 1 non-nuke regimen a good idea fortreament naive patients?That would be a very strong treatment.  I'm not sure if there are individual issues in your wife's care that are making the doctor consider aggressive therapy.3. Are there any treatment issues with us being on different regimensand us having unprotected sex together (as one normally would when married)?- I have been 100% compliant and I am on Ziagen 2x300Mg, Epivir2x150Mg, Stocrin 1x600Mg- My viral load went undetectable in July and my CD4 count isnow 100- She will start her meds next weekThis is a very personal question.  While some might argue for safer sex practices all the time, if you are both undetectable, without resistance, I don't think I would argue against the two of you making whatever decision is easiest for the two of you to live with.Does anyone have any better suggestions for a first regimen based on what Ihav outlined above?I persoanlly like Stocrin better than nevaripine, but if you are considering a pregancy, NVP is the better choice.As a general point, I would stress that your case, once again, should remind everyone that you do not want to find out that you have HIV by getting PCP.  I hope you will encourage your friends to get tested now.  PCP kills, and even if you should survive, the convalescence is long and hard. Barrowpozbod@...

[Guest guest]

D4t causes lipoatrophy at approximately twice the rate of AZT, but you are correct that AZT is not free of that issue:Reference Nolan D et al. Effect of stavudine, zidovudine and HIV protease inhibitor therapy on subcutaneous leg fat wasting in HIV-infected males – a longitudinal study. Fourth International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, abstract 28, 2002.  In the US or Europe, it's easy to recommend tenovfovir, as I mentioned in my first reply, and if available, I would agree with the recommendation.  I'm just not sure how available it is in this person's country of origin. Barrowpozbod@...

[Guest guest]

D4t causes lipoatrophy at approximately twice the rate of AZT, but you are correct that AZT is not free of that issue:Reference Nolan D et al. Effect of stavudine, zidovudine and HIV protease inhibitor therapy on subcutaneous leg fat wasting in HIV-infected males – a longitudinal study. Fourth International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, abstract 28, 2002.  In the US or Europe, it's easy to recommend tenovfovir, as I mentioned in my first reply, and if available, I would agree with the recommendation.  I'm just not sure how available it is in this person's country of origin. Barrowpozbod@...

[Guest guest]

D4t causes lipoatrophy at approximately twice the rate of AZT, but you are correct that AZT is not free of that issue:Reference Nolan D et al. Effect of stavudine, zidovudine and HIV protease inhibitor therapy on subcutaneous leg fat wasting in HIV-infected males – a longitudinal study. Fourth International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, abstract 28, 2002.  In the US or Europe, it's easy to recommend tenovfovir, as I mentioned in my first reply, and if available, I would agree with the recommendation.  I'm just not sure how available it is in this person's country of origin. Barrowpozbod@...

[Guest guest]

The rate of wasting is faster with d4T than AZT, but unless your goal is becoming wasted away, newer drugs like tenofovir (Viread) are a superior choice along with 3TC or Emtriva.

http://www.aidsmap.com/en/news/81924938-D0C6-4B67-8932-DF923D13FDFF.asp

http://www.aidsmap.com/en/docs/B57FC10D-23B8-4AE3-91A0-765AC573ECD7.asp

AZT is indeed the only HIV antiviral which has end-point studies proving that it adds to longevity in people with HIV, but its probably worthwhile to take a chance on the newer drugs which were approved on the basis of improvement in surrogate markers alone.

Personally I can't imagine why AZT or d4T would still be in use, unless your virus has already become resistant to newer, less toxic, drugs.

>> D4t causes lipoatrophy at approximately twice the rate of AZT, but > you are correct that AZT is not free of that issue:> > Reference> > Nolan D et al. Effect of stavudine, zidovudine and HIV protease > inhibitor therapy on subcutaneous leg fat wasting in HIV-infected > males – a longitudinal study. Fourth International Workshop on > Adverse Drug Reactions and Lipodystrophy in HIV, abstract 28, 2002.> > > > In the US or Europe, it's easy to recommend tenovfovir, as I > mentioned in my first reply, and if available, I would agree with the > recommendation. I'm just not sure how available it is in this > person's country of origin.> > > Barrow> pozbod@...>

[Guest guest]

You are so very correct that this is a very long term situation.

I would urge you strongly not to take d4T or AZT. Here's my experience, and why this problem occurs.

Fortunately I was never able to tolerate AZT, and I could only take d4T for two months before I woke up one morning numb from the knees down. I stopped the d4T and recovered my feeling over the next month, although tingling and pain in my legs lasted for another three months. Some people have been crippled for life, walking around with canes, wearing special padded shoes and needing to take morphine every day.

Prior to this, and during this episode, I was injected weekly with IV vitamins and minerals including large amounts of all micro-nutrients. Obviously this did not help. It helped in a lot of ways, but not in preventing this drug toxicity. It has been proven that these problems were especially exaggerated in people with late-stage disease who were malnourished. This is hardly suprising. If you don't have enough real Thymidine around, it enhances the chance that a fake Thymidine will be chosen by your mitochondria or cells.

How do the thymidine analogues AZT d4T and other chain terminators do their damage? These drugs are called "chain-terminators" which means they look enough like Thymidine that they will be able to link to an RNA or DNA chain. But because these drugs are not shaped like Thymidine on the other end, so the RNA or DNA chain cannot continue. This means the virus, cell or mitochondria which incorporates them is now effectively dead, although death may not occur for a long period.

Our cells have a multi-stage discrimination process for sorting out amino acids from fake amino acids like AZT, d4T, 3TC, ddI, ddC, abacavir, tenofovir, and emtriva. This process in our cells does a very good job, although some fake thymidine still slips through. But the mitochondria in our cells (the energy converters) are not protected just as HIV is not.

As a consequence, AZT and d4T progressively kill more and more mitochondria. These mitochondria can never be replaced. All of the nutrients in the world cannot stop this process.

Time has shown that fake thymidine drugs AZT and d4T are the most damaging.

The chain terminator drugs based on other amino acids, 3TC, ddI, ddC, abacavir, and tenofovir, do not appear to be incorporated into our DNA so readily - but the HIV virus does readily incorporate them.

I was on 3TC for many years and now use the newer form of 3TC called Emtriva (emtricitabine). So I know for me, as most have found, 3TC is quite safe.

The problem with abacavir is, in some people, this drug like several others can rapidly kill your mitochondria resulting in lactic acidosis. If you stop the drug immediately, some of the mitochondria can recover from their damage. If you do not this condition is fatal as we cannot live without mitochondria.

While Thymidine analogues damage everyone, or nearly everyone, these drugs linked to Lactic Acidosis damage only some people - although quite severely if your genetics are fooled by these drugs.

This review of lactic acidosis covers this topic. The drugs which can cause this problem in some people are d4T,ddI and abacavir.

http://www.thebody.com/tag/lactic_acidosis.html

Refresh the page once to remove the annoying pop-over box.

Regarding Tenofovir, the "bone problems" found in children using Tenofovir is secondary to kidney damage. You need to monitor Creatinine levels in the blood periodically with a blood test to be certain that your kidneys are functioning normally. My partner experienced this problem - his creatinine level rose - so needed to stop Tenofovir.

Because this can be monitored so easily, Tenofovir still appears to be one of the safest chain terminators, along with 3TC. Tenofovir (Viread) was FDA approved in 2001. This is a listing of approval dates by American brand name.

http://www.fda.gov/oashi/aids/virals.html

> > >> > > A couple of questions:> > >> > > 1. Is the regimen he subscribed adequate for a treatment naive> > > patient?> > >> > > Yes. The combination of D4T, 3TC, and nevarapine should be a good> > > combination, in terms of viral control. I would caution you that> > > D4T is very strongly associated with the complication of> > > lipoatrophy. If another nucleoside such as AZT is available, I> > > would personally prefer that. It isn't clear from your note if you> > > live full time in Thailand, and I'm not familiar with all of the> > > options there. Tenofovir, if available, would be an even better choice!> > >> > > 2. Is adding Kaletra to the 2 nuke, 1 non-nuke regimen a good idea for> > > treament naive patients?> > >> > > That would be a very strong treatment. I'm not sure if there are> > > individual issues in your wife's care that are making the doctor> > > consider aggressive therapy.> > >> > > 3. Are there any treatment issues with us being on different regimens> > > and us having unprotected sex together (as one normally would when> > > married)?> > > - I have been 100% compliant and I am on Ziagen 2x300Mg, Epivir> > > 2x150Mg, Stocrin 1x600Mg> > > - My viral load went undetectable in July and my CD4 count is> > > now 100> > > - She will start her meds next week> > >> > > This is a very personal question. While some might argue for safer> > > sex practices all the time, if you are both undetectable, without> > > resistance, I don't think I would argue against the two of you making> > > whatever decision is easiest for the two of you to live with.> > >> > >> > > Does anyone have any better suggestions for a first regimen based on> > > what I> > > hav outlined above?> > >> > > I persoanlly like Stocrin better than nevaripine, but if you are> > > considering a pregancy, NVP is the better choice.> > >> > > As a general point, I would stress that your case, once again, should> > > remind everyone that you do not want to find out that you have HIV by> > > getting PCP. I hope you will encourage your friends to get tested> > > now. PCP kills, and even if you should survive, the convalescence is> > > long and hard.> > >> > > Barrow> > > pozbod@> > >> >> > > >>