Stribild... Any opinions? Experience?

[VersatileBreeder]

Those of you guys who have followed my other threads know my situation, but for any new guys reading this... Summed up: I recently turned poz, I didn't want it, and was having a major struggle coping with it in the beginning. Many guys on here have really helped me through that first hurdle, which I am extremely thankful for. I am making progress and taking all the right steps to get my health in check so that I can (hopefully) live a long, happy and healthy life.

The latest in these events is I went back to my ID specialist last Friday to consult with him after having all my initial lab work done. The results were 70,000 viral load, 700 CD4 count, the genotype looks fine (no apparent drug resistance). The doctor says that the CD4 is very good, but he believes the 70K viral load is enough justification to get on meds now, if not soon. He says that people get the best long-term results when starting the meds before the CD4 count starts dropping and damage is done to the immune system. I agree with him and I have been eager to get on meds sooner than later anyway. He says that given the sensitivity of the genotype with no resistance, we have many options for a choice of drug, but his recommendation is Stribild.

I have not heard much about Stribild until very recently. Truvada is the drug I always seem to hear of, as well as Atripla (I have a friend who is on it) and Complera. My doctor says that Atripla was his preferred prescription for his patients until Stribild came out because Atripla seems to have common central nervous system side effects (vivid dreams, dizziness, anxiousness, etc) that are not common in Stribild. My friend who is on Atripla mentioned to me that his doctor had told him a while back that taking Stribild can be risky because it is the newest generation of HIV drug on the market and if it fails you, you cannot easily switch to one of the other drugs like Atripla or Complera because now there can be resistance to them, whereas if one of the other drugs failed you, you could migrate to another one including Stribild. All this meaning that if for some reason the Stribild stops working for me, I could be shit out of luck. I am not sure if he was misinformed or misunderstood this information. He also said Stribild is among the most expensive of drugs.

So, I am wondering- what do you guys know about Stribild? Anyone on here taking it? Good results? Anything to watch out for? Naturally, I want to follow my doctor's best recommendation, but at the end of the day, this pill is going to be going into my body and frankly, I am going to have to rely on it to save my life in the long run. I want to make an informed decision as to the drug of choice before just jumping on in.

[fillmyholeftl]

First off, great CD4 number. I know people on Strilbid. Also in my experiences working in the HIV prevention/education field I never heard any negative about Strilbid. I have many friends that are being switched to it. Its easy to take, doesn't matter time of day or food. Atripla you take at night because of the dizziness & Complera (I'm on this) needs to be taken with food. I'd go with Dr. Kocher's recommendation & always feel open enough to ask the same question to him... GOOD LUCK & see you soon

[bearbandit]

Stribild is the new kid on the block. It's a combination of four separate drugs, two of which (Tenofovir and Em.. FTC is the name I name I know it by!) are the components of truvada. What's new in stribild is elvitegravir and cobicistat. It's just been authorised here, so there's little I can say about its effects, however, elvitegravir is a integrase inhibitor, the latest in a new family of drugs. Something that's been observed about integrase inhibitors is that they keep HIV locked up in its hidey-holes for a damn sight longer than any other class of drugs; it's long been known that serological viral load tends to be lower than that of semen, so that someone with an undetectable viral load (serologically) may yet have a detectable amount of HIV in his semen. It seems to be less likely with the integrase inhibitors. Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill. Ritonavir, in other combinations serves the same purpose.

It doesn't matter how old an HIV drug is: I stopped responding to nevirapine about ten years ago, but my virus has had time enough to revert to non-nevirapine resistance. Old drugs can be recycled. If you were to consider Atripla, first question I'd ask is what job do you do? There's a urban legend in London about a crane driver who did half a million' worth of damage before he could be stopped. Another friend (who's a pharmacist) has been told that under no circumstances would his doctor prescribe efavirenz (the part of atripla that affects the CNS). Atripla is likely to be pushed in the next year or or so as efavirenz comes out of patent soon, meaning the drug company that developed it don't see a cent of the profits, and it's liable to be pushed because it's cheap. For the same reason Stribild is likely to be pushed: lotsa money there.

If you possibly can, take a friend who has a good knowledge of ARVs with you to your next appointment...

[mashimaro]

When I first started taking Stribild, I take it at night, I woke up the next day and it seriously felt like I was high. Which is the term I use for a change of perception. Of course that went away, or I got used to it. For the first few months, I avoided driving within a few hours after taking it, because of the sensations it gave me. Of course that went away, or I got used to it. Every now and then I do get a dizzy spell, which started when I first started taking Stribild. I didn't make the connection until recently, but my ID doc doesn't think it's because of the medication. Correlation but not causation maybe? Second thing is diarrhea. I get it every now and then for a few days. For me, side effect wise, that's about it.

A month after being diagnosed my CD4 was 320, and my viral load was 26,943. In six months I am undetectable and my CD4 at 519. So I say good results.

[TigerMilner]

it is the latest and greatest, just like Complera was for me in 2012 and Atripla before that. It is a compound of 4 drugs I understand and the other two are compounds of three. I'd take your doctor's advice. Two of the three drugs in all three are the same, if I am not mistaken. But what you are talking about in terms of drug resistance is an issue if you get re-infected, and with a drug resistant strain. That is how that would occur, at least as far I understand it. But you will have that issue as a remote possibility no matter which drug you ultimately go with. I find good basic, easy to understand info on POZ.com if i need to read up on things. But like my ID Specialist told me, if it was written before july of 2012, is out of date information.

[fillmyholeftl]

Tiger, that's great info... I was on Atripla in 2008 until about 9 mos ago, now on Complera. Not due to any problem with resistance, or that... just to get rid of the sustiva component in Atripla. You are correct about all three having 2 ingredients in common.

it is the latest and greatest, just like Complera was for me in 2012 and Atripla before that. It is a compound of 4 drugs I understand and the other two are compounds of three. I'd take your doctor's advice. Two of the three drugs in all three are the same, if I am not mistaken. But what you are talking about in terms of drug resistance is an issue if you get re-infected, and with a drug resistant strain. That is how that would occur, at least as far I understand it. But you will have that issue as a remote possibility no matter which drug you ultimately go with. I find good basic, easy to understand info on POZ.com if i need to read up on things. But like my ID Specialist told me, if it was written before july of 2012, is out of date information.

[VersatileBreeder]

Hey bud, good to hear that you see and hear good things about Stribild. So far, I have had great experience with the good Dr. Kocher and I intend to follow his best recommendation and ask any necessary questions along the way. Thanks for the well wishes and I'll see you in NJ!

First off, great CD4 number. I know people on Strilbid. Also in my experiences working in the HIV prevention/education field I never heard any negative about Strilbid. I have many friends that are being switched to it. Its easy to take, doesn't matter time of day or food. Atripla you take at night because of the dizziness & Complera (I'm on this) needs to be taken with food. I'd go with Dr. Kocher's recommendation & always feel open enough to ask the same question to him... GOOD LUCK & see you soon

[VersatileBreeder]

Bearbandit, sounds like you know a thing or two about Stribild . One thing I am just curious about, you said in your response, "Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill." What do you mean when you say it preoccupies the liver into getting rid of it?

As far as if I were to consider Atripla, I am a teacher, so I am not working with dangerous machinery like the urban legend you mentioned about the crane driver in London. Then again, I wouldn't exactly want to have anything happen that would impair my teaching or even worse, driving a car. So those are a couple of things I would be wary of.

I didn't mention this in my original thread, but I was on PEP once before (last summer actually). So, this actually isn't my first rodeo with HIV drugs. I was put on a 28 day course of Truvada and Sustiva. I remember the first two days I was on it, all the muscles in my entire body got painfully sore, but it went away quickly. I also got a little bit dizzy, but I was able to get over it quickly too. Nausea was a minor issue in the first couple of weeks, more of an annoyance than an actual problem. I never got nauseous to the point of vomiting. So, if Stribild has less common occurrence of side effects, I would say that I would probably be fine with it.

Stribild is the new kid on the block. It's a combination of four separate drugs, two of which (Tenofovir and Em.. FTC is the name I name I know it by!) are the components of truvada. What's new in stribild is elvitegravir and cobicistat. It's just been authorised here, so there's little I can say about its effects, however, elvitegravir is a integrase inhibitor, the latest in a new family of drugs. Something that's been observed about integrase inhibitors is that they keep HIV locked up in its hidey-holes for a damn sight longer than any other class of drugs; it's long been known that serological viral load tends to be lower than that of semen, so that someone with an undetectable viral load (serologically) may yet have a detectable amount of HIV in his semen. It seems to be less likely with the integrase inhibitors. Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill. Ritonavir, in other combinations serves the same purpose.

It doesn't matter how old an HIV drug is: I stopped responding to nevirapine about ten years ago, but my virus has had time enough to revert to non-nevirapine resistance. Old drugs can be recycled. If you were to consider Atripla, first question I'd ask is what job do you do? There's a urban legend in London about a crane driver who did half a million' worth of damage before he could be stopped. Another friend (who's a pharmacist) has been told that under no circumstances would his doctor prescribe efavirenz (the part of atripla that affects the CNS). Atripla is likely to be pushed in the next year or or so as efavirenz comes out of patent soon, meaning the drug company that developed it don't see a cent of the profits, and it's liable to be pushed because it's cheap. For the same reason Stribild is likely to be pushed: lotsa money there.

If you possibly can, take a friend who has a good knowledge of ARVs with you to your next appointment...

[bearbandit]

Bearbandit, sounds like you know a thing or two about Stribild . One thing I am just curious about, you said in your response, "Cobicistat is a booster drug: it preoccupies the liver into getting rid of it rather than the more active drugs in the pill." What do you mean when you say it preoccupies the liver into getting rid of it?

It serves the same purpose as ritonavir and uses the exact same enzyme to be metabolised. Bit of history: I don't know if they happened in the USA, but in the UK we had a rash of deaths because of ecstasy poisoning. It turned out that these ecstasy poisoning deaths had one common factor: ritonavir. In those days the standard dose of ritonavir was up to 800mg or more per day and, yes it pushed its way to the front of the queue for processing through the liver, leaving other drugs, whether prescribed or not, behind. Ritonavir in that sort of dosage has a bad record: it can also cause metabolic syndrome and diabetes. Hence the search for a P450 blocker like cobicistat to pre-empt the processing of other drugs, meaning that they can be prescribed at loser doses. Cheaper for everybody and less strain on the system. If you've never experienced high dose ritonavir, believe me, you don't want to!

[RWHID]

Stribild is what I've been on. I was told in December that my VL was going down and my CD4 was going up. My CD4, from the last test before I started was 140. I go back in the morning for an update, but they said it is doing its job.

[Bear4Breeding]

I've not heard of this one. I started on Atripla, it was bad for me, it shot my Triglycerides through the roof and now I am on Complera. I am undetectable and my CD4 is 1140.

[bearbandit]

Stribild is the new "Quad pill", so called because it contains four different drugs. Atripla contains two of those drugs (FTC and tenofovir). Complera I know little about but know people who are using it successfully.

I am undetectable and my CD4 is 1140.

Something's obviously working! I've hit zero as viral load, but I've never been above CD4 880. My advice, as ever, is "if it ain't broke, don't fix it". In the "old days" when it was felt you couldn't go back to a class of drugs that had failed you (but then there was an awful lot else we didn't know that we know now). The big difference between then and now is that we didn't know how the correct dosages and we didn't know how to safely swap out of combinations: a friend of mine has just swapped out of nevirapine after fourteen years on the stuff.

The ones to watch for and report any side effects to your doctor (though obviously you should be reporting the lot!) are efavirenz because of its CNS effects and tenefovir because the kidney damage seems to be permanent: I've just been recalled by my diabetes clinic as they're not happy with with my last bloods following prescription of a blood pressure medication. (Just as well I've got nothing lined up involving heavy poppers use!)

[RWHID]

I got new good news today from my visit. The Stribild seems to be working. My VL went from 47,000 (I believe) to 700, my CD4 went from 140 to 270. She said by the time I come back in 3 months I could be undetectable. We shall see. Just wish I could get my CD4 to boost up more.

[Barehole4u]

Stribild is working out great for me. I have just completed a full year on this medication and am still UD with CD4's on the rise. No real side effects. Sometimes some gas and bloating, but not much or often. Do take it with food. This is called for in the package insert. The drug requires stomach acids to breakdown the medication properly.

Prior to Striblid, I did eight months on Atripla. Those eight months were a nightmare of CNS issues. While Atripla got me from a VL of 3+ million to UD in less than eight weeks, I just could not tolerate the brain fog, buzzing sensation, bitter taste in mouth, sleep disturbances, etc. The only part I liked were the raging boners I would get every night

Edited February 28, 2014 by Barehole4u

[AlwaysOpen]

I have been doing Isentress( 2 caplets) and 1 Truvada once a day for the past 3 years or more, and have stayed undetectable and had minor increases in my T cell counts while on it. My doc saw me this past week to go over my labs- these were the 1st labs of the year and were after my weekend of sleaze in DC for MAl, and several very active sessions here in Ft Lauderdale over the last 2 months. My T count hit a new high, I was undetectable again- and oddly(shockingly surprising) none of the tests came back with any traces of any STD's !! I told the doc he had the wrong report- with all the things ( and then I detailed some of them) I have been doing, I HAD to be reactive to at least something- -he mentioned even the RPR test came back non reactive, in spite of me having had Syph once or twice in my past. As we chatted, he mentioned he might want to switch me over to Stribald , but there was no rush nor any medical need, other than dropping the number of pills I take from 3 to 1, and the number of co pays I have to lay out from 2 to 1. And then he said he NEEDED to check my prostate ( hmm, did he really say it like that or was my fantasy brain in gear again??) After he had poked in and rubbed around, I asked him if he was in yet -- he laughed and said to hold the pose while he brushed my ass-- and then he stuck a small bristle brush in to do a pap smear. I think it was the 1st time I have had that done- but a medical friend says it is becoming very common to do on men