Showing posts with label isentress. Show all posts
Showing posts with label isentress. Show all posts

Friday, August 17, 2012

Is the best HIV drug bad for muscle? Isentress increases CPK




CPK is creatine phosphokinase, an enzyme found mainly in the heart, brain, and skeletal muscle. It is tested by taking a blood sample.

High CPK can indicate muscle destruction, heart attacks, central nervous sysmtem issues, and others. Long term exposure of high CPK can load up your kidneys, and may cause muscle loss and weakness.

A CPK blood test is usually not included in the usual lab work unless you ask for it. Sometimes we have no symptoms when CPK is high, but most of the time we have body aches and soreness. CPK can increase with exercise, but if you exercise frequently and you have baseline CPK info, you can tell what may be drug induced after you start a certain medication.

To make sure your high CPK is not induced by heavy exercise, do not exercise for 5 days and have another test done after that.

Some medications can also increase CPK. Among them are amphotericin B, ampicillin, some anesthetics, blood thinners, aspirin, clofibrate, dexamethasone, furosemide, alcohol, and cocaine. HIV medications like Isentressand Selzentry have also been reported to increase CPK in some patients.

Low thyroid function can also be a cause of high CPK, so get it checked.

There is no treatment. If CPK gets really high, doctors try to switch you to another medication, but it is very difficult for some patients to switch since they have no other options.

Some doctors prescribe corticoid steroids to reduce whatever the inflammation may be, but this is not a cure. Corticoid steroids can lower bone density, cause water retention and fat gain, and have been linked with joint bone dealth (necrosis), so they are not a good option to stay on for the long term.

If you are taking statins with or without fibrates, high CPK may indicate muscle related problems that these drugs can cause in some people. Statins (with or without fibrates) can cause rhabdomyolysis which can cause dustruction of muscle tissue in few patients and increase CPK. Some patients have anecdotally reported improvements of this problem by taking Coenzyme Q-10 (statins lower it) and a good antioxidant formula.

In the old days of heavy AZT use, we used to experience muscle myopathy and high CPKs that were sometimes successfully treated with L-Carnitine. I have not seen any data on the use of this supplement for high CPK induced by newer HIV drugs. I use it but my CPK is still higher than normal (If I do not exercise for 2 weeks, my lowest CPK is 400)

In my opinion, high CPK is an under diagnosed issue in aging HIV patients and one that needs to be researched. I am tired of companies denying that their drugs do not cause it. Hopefully, a researcher will read this post and think about innovative ways to manage this side effect.

The HIV-1 integrase inhibitor raltegravir is associated with rare cases of rhabdomyolysis, and pooled safety data from Phase II and III clinical trials show a higher rate of grade 3-4 creatine kinase (CK) elevation in patients receiving raltegravir versus controls (4.2% versus 2.5%). We compared the frequency of skeletal muscle toxicity in HIV-infected adults receiving raltegravir compared to a control group not receiving raltegravir, analysed for associated factors and also assessed for evidence of myocardial toxicity.

This published report shows that raltegravir (Isentress) can increase CPK in some patients:



Is Raltegravir Bad for Muscle?
Investigators from Australia followed up on reports of CK elevation from clinical trials of raltegravir by conducting a prospective study assessing CK elevations, myalgias, and myopathy in HIV-infected persons receiving (n=159) or non receiving (n=159) raltegravir (CW O016).  Skeletal muscle toxicity was defined as either: (1) isolated CK elevation; (2) myalgia without motor weakness; (3) proximal myopathy on physical examination; or (4) rhabdomyolysis

Wednesday, June 20, 2012

Nucleoside and Norvir Free HIV Medication Regimen May Provide an Option for Patients with Kidney Problems










http://www.hivandhepatitis.com/hiv-aids/hiv-aids-topics/hiv-treatment/3629-nrti-sparing-art-with-atazanavir-raltegravir-conflicting-data-for-naive-and-experienced-patients 


 NRTI-sparing antiretroviral regimen of unboosted atazanavir (Reyataz) plus raltegravir (Isentress) suppresses HIV in treatment-naive patients as well as standard 3-drug combinations, but its twice-daily dosing, side effects, and low barrier to resistance limit its appeal. For treatment-experienced people already doing well on atazanavir triple therapy, however, the dual regimen may be an attractive simplification option.
According to the latest U.S. antiretroviral treatment guidelines, preferred first-line regimens consist of a NNRTI, a ritonavir-boosted protease inhibitor, or the integrase inhibitor raltegravir, all combined with 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs and ritonavir can cause multiple drug toxicities, however, prompting researchers to explore alternative regimens.

My comments:

I bet this nucleoside-free regimen could do even better when it comes to side effects if the Reyataz (atanazavir) dose was cut to 150 mg twice a day instead of the 300 mg twice a day. However, this lower dose of atanazavir has not been tested in combination with raltegravir, so patients should not take the risk to experiment with it.

I think twice a day dosing is not a big deal, no matter how bad pharmaceutical companies and clinicians make twice a day dosing to be. Many patients will be happy to take a twice a day combination if they do not have to be exposed to nucleosides.

I really believe this is a great option for patients who do not want to take nucleosides  due to kidney and bone issues, or who have hypersensitivity to abacavir.

Both raltegravir and atanazavir boost each other, but it seems that raltegravir boosts atanazavir so much that 20 percent of patients experience high bilirubin, a common side effect of atanazavir.

Note: Nucleoside-free combos are not recommended with patients coinfected with Hepatitis B and HIV (Tenofovir, a nucleoside analog, is also a treatment for Hepatitis B)


Tuesday, March 06, 2012

Fw: Hot Topics at The Body's "Ask the Experts" Forums



From: "News at The Body" <update@news.thebody.com>
Date: 06 Mar 2012 15:17:15 -0500
To: <nelsonvergel@yahoo.com>
ReplyTo: "News at The Body" <update@news.thebody.com>
Subject: Hot Topics at The Body's "Ask the Experts" Forums


If you have trouble reading this e-mail, you can see the online version at: www.thebody.com/topics.html

March 6, 2012

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LIVING WITH HIV/AIDS

 Are You Giving Up on the Cure?
I was reading your last response about a functional HIV cure in which you claimed that it would most likely take more than 10 years to develop a cure. Reading your previous responses on the issue you seemed much more optimistic. What happened?

Nelson Vergel responds in the "Aging With HIV" forum

MIXED-STATUS COUPLES

 How Much of a Risk Are We Taking With Unprotected Oral Sex?
I'm an HIV-negative man and my girlfriend is HIV positive with a viral load of 200,000 and a CD4 count of 750. Oral sex is very important to both of us. I've performed unprotected oral sex on her multiple times, and vice versa, and we're careful about sores and cuts; we always use condoms for intercourse. I've read literature that says anything from there's no HIV risk with unprotected oral sex to I'm most likely already infected. What do you think? Do you know of any documented cases of someone contracting HIV from oral sex on a female?

Shannon R. Southall responds in the "Safe Sex and HIV Prevention" forum

INSURANCE, WORKPLACE & LEGAL CONCERNS

 How Can I Get Health Coverage Back for My Registered Domestic Partner?
I'm a retiree in California and have health coverage through my (former) employer, a large California-based aerospace company. My registered domestic partner has had health coverage for the past five years as my dependent. For 2012 my employer is denying coverage for domestic partners. Any idea why they can now refuse coverage, and what we can do about it?

Jacques Chambers, C.L.U., responds in the "Workplace and Insurance Issues" forum


 Two Chiropractors Refused to Treat Me: What Can I Do?
Two different chiropractors have refused to treat me due to my HIV status, directly stating that they didn't have the proper gloves or facilities to treat "people like me." Are there grounds to sue based on this type of discrimination? What actions can I take?

Christa Douaihy, Esq., responds in the "Legal Issues and HIV" forum

the latest in hiv research: croi 2012 @ thebody.com

Seattle What's coming down the pipeline in HIV treatment, prevention and care? CROI is the largest annual science meeting in HIV, where researchers and clinicians go to learn the most important lessons and developments in the field. The gathering began this weekend, and TheBodyPRO.com -- TheBody.com's sister site for health professionals -- will be on hand to bring you wide-ranging coverage.

Visit our CROI 2012 home page frequently this week for key study summaries and a discussion of conference highlights!

HIV/AIDS & HEPATITIS C TREATMENT

 What's New With Ibalizumab?
I've had very good luck with ibalizumab, the drug in development (TNX-355, formerly known as Tanox). Can you give me an update on what's going on with this drug in 2012? Are there any new developments we should know about?

Nelson Vergel responds in the "Nutrition and Exercise" forum


 Do Calcium and Magnesium Have a Negative Effect on Isentress?
I switched to a regimen of Isentress (raltegravir) and Truvada (tenofovir/FTC) recently and am doing very well on it so far. Every morning I usually drink a glass of milk after taking Isentress. I also take vitamin D and calcium supplements. I heard somewhere that calcium and magnesium can affect the effectiveness of Isentress. Is it true? Should I stop drinking milk when I take Isentress as well?

Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum


 Another Time Around With Hepatitis C Meds: For How Long Will I Be Treated?
I'm a 55-year-old man with hepatitis C genotype 1B (my initial viral load was 3.8 million) and in otherwise good health. I'm currently 20 weeks into triple therapy with Incivek (telaprevir), peginterferon and ribavirin, and my hepatitis C viral load was undetectable at four, eight and 12 weeks. I've been unsuccessful on dual therapy before. What does this mean for the length of my treatment course now?

Barbara McGovern, M.D., responds in the "Hepatitis and HIV Coinfection" forum

OTHER HEALTH ISSUES & HIV/AIDS

 Positive Anal Pap Smear but Negative HRA: What's Going On?
I've been HIV positive for four years, with a CD4 count of 330 and an undetectable viral load for the past three and a half years. Recently I had a high-resolution anoscopy (HRA) and the examination didn't show any abnormalities, so I was relieved at that. However, my anal Pap smear result showed anal intraepithelial neoplasia (AIN 2). Should I be worried about precancerous changes in my anal canal? How do you interpret these results? If I have HPV (human papillomavirus), how long would it take an HIV-positive person like me to get rid of it?

Nelson Vergel responds in the "Aging With HIV" forum


 How Do I Know if I'm Depressed?
I take Isentress (raltegravir), Selzentry (maraviroc, Celsentri) and Viramune (nevirapine). I've been HIV positive for 22 years and I'm doing well. However, lately I've been losing my drive to exercise and eat well, as I have for the past several decades. I still go dancing every weekend and have a great group of friends, but being single and keeping healthy just for myself is getting hard at age 63. Is this the state of mind the younger generation calls depression? Could it be a side effect of HIV meds? Do you think I'd take better care of myself if I were in a relationship?

David Fawcett, Ph.D., L.C.S.W., responds in the "Mental Health and HIV" forum

Connect With Others
Pen Pal for a Poz Friend in Prison?
(A recent post from the "Living With HIV" board)

A friend of mine is HIV positive and has been in prison for the past 27 years for a crime he didn't commit. Recently the Innocence Project has taken his case and they have hopes of having my friend released. He became HIV positive while being held in protective custody in 1985. I am hoping to connect him with someone who would like to be a pen pal / friend to him and answer some of his questions about living with HIV. Would anyone out there be interested in contacting him? -- DawnW

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HIV & HEPATITIS TRANSMISSION

 Can a Person With Hepatitis C Donate Organs?
Could someone living with hepatitis C (hep C) donate their organs (besides their liver) to others in general? Could they give organs to other people living with hep C?

Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum


 Why Was I Tested for HIV?
I just officially found out I'm pregnant. I already took a preliminary, preconception HIV test six months ago and it came back negative, but I was sent out for another test today. Why would they do this, since my husband and I are completely monogamous with each other and have participated in no other risky behavior since my last test? Is it possible that the first test was a false negative or was not done correctly? Do I need to be concerned?

Shannon R. Southall responds in the "Safe Sex and HIV Prevention" forum


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