Q and A

Question

Can I stop treatment due to my new combination…

I have been on antiritrovirals since 2006. I have maintained an undetectable viral load for all these years and have also take my medication as expected.

I have taken Kaletra and Truvada for almost 10 years with no side effects at all! then, suddenly i was under pressure from my doctor to switch over to a newer medication. I was told Truvada and Kaletra would need to go as they are trying to get rid of the meds.

I was switched to Stribild which is a one tablet a day since July 2014 and my liver results seem to have increased and also i feel slight pains in the area, plus constant headaches, thirst, weakness, confusion and memory loss.

I will be meeting with my doctor on monday and I plan to switch back to Kaletra and Truvada. My viral load is undectable and my CD4 is 1200.

I am thinking of stopping medication totally as I have realised how powerful this medications are and I am afraid of the long term effects. Could I go off them and go for regular CD4 and Viral load check and go back on them again if my viral level increases.

Please can you tell me how to stop these medications in a controlled manner so i don’t get resistance to them. Before I started medication in 2006, my CD4 was around 200 but has remained above 800 all this years! … please help!

Answer

Hi

Thanks for your question – and for all the background information which is really helpful.

It is good you are seeing your doctor soon to discuss this. Please don’t stop treatment before this. There are lots of other options that will be better and safer. Your doctor will also need to talk about these with you.

Firstly, I’m sorry you have been unlucky with the switch. There are lots of reasons why for most people this would have been a better and safer treatment and it sounds like you have just been unlucky. Is is easy to switch back to your old combination if this is what you prefer.

Secondly, some of the symptoms you describe sound more related to kidney function that liver problems – and this has been reported as a caution for Stribild. Your doctor needs to check this out properly, but please call your clinic beforehand to tell them about this as they may want to see you more quickly.

There is much more safety data to support staying on treatment – even with your old combination – compared to stopping treatment. Several years ago a very large study called SMART reported that stopping treatment increased the risk of  serious complications. These included a higher risk for heart, liver and kidney complications in people who stopped treatment and also a higher rate of some cancers.

If you stop treatment – which is still an option – your viral load is likely to rebound within a few weeks and your CD4 will drop again. In the SMART study, most people who took a treatment break were not able to recover their CD4 count to earlier levels even after starting treatment for 18 months.

2 comments

  1. Simon Collins

    Hi Kenneth

    Your doctor is giving you good advice. In the UK, if people have trouble with efavirenz, then rilpivirine is often used instead.

    It is easy to just switch one drug for another, especially now your viral load is undetectable.

    The smaller mg dose is just as good – it just means that rilpivirine is a more potent drug so not as much is needed.

    Two things are important though with this switch:

    1) Awasy remember to take rilpivirine with food. This can be any type of food but needs to be at least 400 kcal.

    2) Please be careful to aim for the same time every day. Efavirenz has more flexibility if you are a few hours early or later – or even if you miss a day. Rilpivirine is not as strong in this way – so try to get within the same 1-2 hour window each day.

    You have got such good viral load and CD4 results that making sure you don;t have side effect is now just as important.

  2. Kenneth

    Previously my viral load was 144000 copies and cd4 was 333 before I started treatment early Feb 2016. Last fri which is Jul 2016 my viral load is undetectable and my cd4 is 414. The sad thing is I’m taking efavirenz plus tennovir. Efavirenz make me can’t sleep well.

    Last friday the doc suggested to change to rilpivirine due to my success with viral load suppression. Now I worry is the new rilpivirine is it will cause my viral load rebound or cause resistance? And will rilpivirine be as effective as efavirenz to continue suppress viral load in long run as it only contain 25 mg compare with efavirenz 600mg? Thank you very much for the advise. Appreciate so much

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