Question
Are there advantages of switching to raltegravir and darunavir?
13 November 2008. Related: All topics, Changing treatment, Resistance, Side effects.
I have a multi-resistant virus, but I have been on a successful ARV regimen for the past three years, thanks to twice-daily doses of Tipranavir boosted with Ritonavir; a one-a-day dose of Truvada; and twice daily injections of T20.
As a result, my viral load has remained undetectable for all this time, and I have a CD4 count of 400 – which is great, because it was at 9 when I was first diagnosed!
I have no issues with adherence, and I’m perfectly ok with the injections. Just as importantly, I have never had any bad side-effects, so I know that I’ve been really lucky with this.
However, I travel quite a lot for my work, and it means I often have to take a second bag just for the mountain of plastic that is necessary for the T20 (which is basically the sealed syringes).
I mentioned to my consultant that I’d like to know if there were any new alternatives available to me. He has now suggested that I replace the Tipranavir with Darunavir, and the T20 with Raltegravir (Isentress). I’m so happy at the thought of shedding the extra luggage, but at the same time I’m apprehensive of changing the regime when what I’m on now works perfectly well, and my quandary is that if it aint broke, why fix it – and risk possible nasty side-effects.
I can’t say I’m fond of injecting, but I’d rather not jump out of my cosy little frying pan into the fiery world of relatively unknown success of the two newer drugs. I can only find online information for either of them that shows successful drugs trials results up to just 48 weeks.
Maybe you may know more about the long-term success of these drugs than I can find out from the internet, or maybe you have some first-hand (or second) experience from people currently taking one or both of them? I’ll talk to my consultant about this, too, but there’s nothing like an honest opinion from someone who’s been there.
I’d be grateful for any help or advice. Thank you!
Answer
I don’t have personal experience of either of these drugs, but the trial results for both of them are pretty impressive.
Darunavir should work just as well as tipranavir for most people (your doctor needs to check results from your resistance tests with a resistance expert first as there are some cases where tipranavir is still better) and has the big advantage of needing much lower ritonavir doses to boost it. This is definitely a benefit as ritonavir is associated with a range of side effects and lower doses are better.
Raltegravir will be active against your HIV because it is a new class of drug (an integrase inhibitor) and safety results also look good. There are no major side effects relating to liver, kidney or heart problems, and unlike most other HIV drugs, it doesn’t increase cholesterol or triglycerides.
You are right to be cautious – and other side effects might emerge later – but currently, so long as the resistance results are good, both these drugs look better in terms of tolerability and quality of life than your current treatment.
Several studies at the recent Mexico City conference reported on the safety of switching from T-20 to raltegravir and we reported these with links to the study abstracts here.
Two year results are also now available for both drugs – see this report for raltegravir and this one for darunavir.
This isn’t so much a question of your current treatment being broke, but more about how scientific advances can offer benefits from newer medications. Often people put up with difficult side effects when they are are using life-saving medications but there is no need to do this if you don’t have to. T-20 for example is still an excellent drug if there are no other choices, but the recently approved drugs mean that many people will be able to safely switch if they want to.
Good luck with whatever you decide.
Simon
PS – This is also covered in the new (November 2008) US treatment guidelines (see pages 61-62 of the PDF file at this link).
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