Question

Can I change to a simple combination? can I just stop a drug?

4 January 2018. Related: Access to treatment, All topics, Changing treatment, Side effects, Support.

About 12 months ago my consultant, retired and I got a new one. She I took me off Atripla due to damage to my kidneys. I was on it for about 6 years.

I was put onto abacavir/lamivudine 600mg/300mg once daily plus raltegravir 400mg twice daily.

I started to get bad diarrhoea and I also started to get very depressed and attempted suicide.

12 months ago I only took Atripla and Mirtazaine 45mg. Two pills daily.

Over the course of the year I have been put on so many medications – now about 12.

In December my viral load spiked to 60 copies and my hiv consultant has increased the raltegravir from 400mg twice daily to two raltegravir 600 mg pils at night. Since starting this. I’m hardly sleeping. I have headaches. My skin is terrible. And two days ago I broke out in abscess under my armpits and terrible ear ache.

My HIV+ friend advised me to stop immediately the raltegravir as he is aware of my mood swings and depression, and had noticed it getting worse. He didn’t know which hiv treatment I was on till today. He told me to switch consultants as he had and he had similar doubts with her prescriptions. He also told me about i-Base.

I don’t know what to do. Should I stop taking them? Would this be detrimental to my viral load/resistance etc? I am going  get a new consultant ASAP.

Any advise please?

Answer

Answer: Simon Collins

Thanks for your questions and for letting us post an answer online.

As you are have trouble and the history is complicated I thought it better to contact your directly first.

If everything was okay when on Atripla and the only reason to change was concern about your kidneys, one option it to return to that combination. It will not be exactly the same though because there is a new version of tenofovir that doesn’t affect your kidneys.

So instead of efavirenz plus FTC plus tenofovir DF, you would use efavirenz plus FTC plus TAF. This would involved taking two pills rather than once with Atripla, but it would be less than everything you are taking now.

However, because you have since talked about suicide and depression, you could only do this if you are sure that Atripla wasn’t also causing mood changes. As you were taking mirtazapine (an antidepressant) when on Atripla, it might be better to use an alternative to efavirenz (as the efavirenz in Atripla can cause mode changes and depression).

Also, although the raltegravir dose seemed like an increase, you are still only getting the same amount of active drug with the new once-daily version of raltegravir.

Please do not stop any treatment without your doctor discussing this first. The change in raltegravir formulation is unlikely to have caused any new symptoms but you would risk developing drug resistance from using fewer drugs.

If your would prefer to talk it is easy to call the i-Base phoneline. Although the advertised hours are Mon-Wed, I am in the office today and tomorrow too and we take calls outside the advertised hours is someone is here.
https://i-base.info/qa/phoneline

This would be a way to talk in more detail about your history and options, including the relationship with current doctors and clinic.