Wednesday, January 8, 2014
Changing From Atripla to Stribild
In June 6, 2011 I was diagnosed with HIV. I knew that I immediately wanted to go on medications and I was immediately enrolled into a drug study that was open label. I end up on the Atripla arm. Initially I tolerated the Atripla very well. Life was great. Within 5-6 months I was undetectable and life returned to "normal" whatever that is.
I had been warned about the "Atripla dreams" and to be honest it never bothered me, initially. I found that the key to Atripla is low-fat diet. The sustiva component in Atripla interacts with fat which is what causes the dreams to be worse. For the first year life was great and I was extremely happy. If it wasn't for the activism and advocacy that I did, it would have been extremely easy to forget that I was living with HIV. I think that this says a lot about what life is like for a patient today.
Before I knew it, my 52 weeks study was coming to an end and I faced the decision of what I wanted to do next. One one hand I could stick with Atripla which I was tolerating well or I could switch to Stribild. I had read articles weighing in on atripla and damage to neurons and this was particularity-worrisome. After many conversations with my doctor, I made the decision to enter into a second study but if side effects worsened I would break study and come off. I was hoping that I would be randomized into a different drug however I was placed into another Atripla arm which would last for 52 weeks.
There were things that I had to consider when making the decision, namely financial. At that time I had insurance however I was waiting for the "pre-exisiting period" to end so HIV would be covered. I was aware that stribild costs around $2900 a month as well as quarterly lab work is about $1500.
A few months after I started the second study I noticed that the systems were really becoming more pronounced. I tell everyone that for the entire time that I was on Atripla I dreamed and that gets extremely tiring. It is almost as if your brain never gets to shut off. For a majority of the time that I was on Atripla I have had to take sleep-aides such as Ambien in order to get any meaningful sleep.
Every time that I would have a doctor's appointment, which when you first start a study is Day 0, 2 Weeks, 4 Weeks, 12 weeks out to 52 weeks. Each study is different though, but for this particular study that was how it worked. In October/November of 2013 I had a trip to Washington, DC for a leadership meeting with the AIDS Clinical Trials Group. While in DC I had a horrible dream where in the dream I progressed to end-stage AIDS which required me to go on hospice.
The unique thing about Atripla dreams is that everything is real. You can recall taste, sound, smell and everything in between. When I returned back to St. Louis I spoke with my Doctor however I still wanted to continue. The good thing about Atripla is the penetration of the "Blood/Brain barrier". From my work with the ACTG I have come to understand that a person living with HIV can have different levels of HIV in their system i.e. spinal fluid, semen, blood, breast milk, vaginal fluid. It was becuase of this that my general practitioner who is also an infectious disease physician decided to continue on with Atripla.
The last 2-3 months however that I was on Atripla the sleep interruptions became more than I could handle. Every night I would wake up around 3-330am. It did not matter what my diet was or that I was taking ambien. Also concerntration really became and issue that could not be ignored any longer. Over the last few months I have spoken with several physicians and advocates that all encouraged me to change my medications. I explained that I was concerned about developing a resistance if I change medications. I also have always heard that a person should stay on their current regimen until it fails. I was lucky when I tested positive in that I was sensitive to all medications and I did not have a variant strain of HIV. One of the doctors made the following statement to me that made me think. He said, "Aaron, if you are having side effects from Atripla, why not switch to stribild? You have options and you should not be miserable due to the medications." This really made me think as well as be thankful that I do have options.
Two weeks ago I made an appointment with my doctor's office with whom I have been with for close to ten years and I anxiously awaited the appointment. January 7, 2014 at 1215 was my appointment. The day came and I went to see my doctor. While the nurse was screening me she asked what the reason of my visit was and I proudly proclaimed, "I need to reconsider my HIV regimen." When the doctor came in he already knew what I wanted to do since we had talked about it multiple times during the previous 6-8 months. We talked about what I could expect with Stribild, how long atripla would stay in my system (about a week) and then we talked about insurance issues. With that the appointment came to and end and I waited for the pharmacy to fill the order.
I am fortunate that I have a Walgreens specialty pharmacy right in the doctor's office where I go (Southhampton Healthcare). The staff worked with the insurance company to get the prior authorization and then explained that I am going to now be using mail order. My pharmacist explained that I would need to take stribild with medication as well as the potential side-effects.
That evening I decided that I was going to take the medication at 6pm since I have to take it with food. I do not always eat breakfast and lunch is never during a regularly-set time. The clock clicked closer to 6pm and I went into the kitchen and made half a sandwich and then I popped the big, green pill. The rest as the say is waiting. Ask I sat and read over side-effects an stuff, I started to get panicky. I mean, for the last 2 1/2 years I have been on a medication that I have taken every night right before bet. No matter what I was doing I did this same routine and now I was changing it. In some ways I felt like I was abandoning a friend that had been with me sine those early days. When I as first diagnosed my viral load was over a million and my CD4 was 678. Now though I was changing everything.
For a split second I thought that this was a huge mistake. Was I feeling something? Was this new medication going to give me fatigue or make m e nausea? I guess after 2 1/2 years of perfect health, having mild nausea depending on things I had eaten, sleep interruptions and so on, I had gotten use to atripla. All medications have side effects but we sometimes fail to remember that because the medications have improved so much.
I finished the night out while watching television and then went to bed. I woke up the next morning and the first thing that I did was look at the clock and I was thrilled to see that it read "550am". For the first time in almost 2 1/2 years I had slept through the night. While I did have dreams they were nothing like while I was on atripla. Those two things alone already tell me that I made the right choice in switching to stribild.
I just finished taking my second dose of stribild at 6pm and as of yet I have not had any side effects. I will be sure to keep you posted. I would definitely say that if you are having side-effects from your medications that you need to talk to your healthcare provider and changing medications if it is appropriate. There is no need for you to be miserable from side effects while there are many options out there for those of us that are living with HIV.