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moderated Private: Re: NATAP: Weight Gain & Integrase Inhibitors

Jules Levin
 

As I see it we can’t win. You have to be on ART to sustain viral load <50 and optimize your cd4 - without that your dead. Yet every class of ARTs and every drug has long term adverse effects. You didn’t mention ART neurotoxicity which also is a long term potential bad affect. Yes bad affects on kidney, heart, bone, diabetes, lipids are all potential adverse effects by various drugs. And hiv itself also increases the risk for all these comorbidities. The best one can do is find the least  regimen. One that works best for you. Today integrase inhibitors are very popular, they just came out a few years ago and they looked the least offensive until this weight gain issue was identified. Atazanavir is a PI but also causes elevated bilirubin which studies however find it might be protective of heart disease, but atazanavir has been found associated with bone disease. Darunavir and atazanavir both require ritonavir which increases TAF and TDF levels. Integrase inhibitors can cause CNS side effects but so do all the NNRTIs which mean they affect the brain. The thinking is that integrase is in general the least offensive. If one experiences on an integrase CNS effects they don’t like and excessive weight gain they can switch off. Doravirine is the new NNRTIS just FDA approved, so far it appears to have no affects on lipids, appears to maybe not have the usual CNS side effects that other NNRTIs have. The real problems appear to emerge as one reaches around 65 years old when the aging syndrome affects can kick in, when cognitive impairment might worsen, when osteoporosis and heart disease become a greater concern. Older HIV+ have on average double the prevalence of these comorbidities compared to older HIV-neg. so you have to try to pick a regimen that works best for you. In older age many have to take non ARV medications for various conditions that might interact with ritonavir, another concern. In the end when weighing all this the reason integrase is the most popular and dominates first line recommendations by guidelines is because right now they appear to be safer. Another point is DTG and bictegravir raise creatinine but it’s considered harmless, just an artifact, but if you are tracking your creatinine because you have kidney dysfunction it is difficult to know for sure if your creatinine is going up. In the end all the guidelines have integrase inhibitors as their best first line regimens.


On Oct 6, 2018, at 8:15 PM, Steven Hooper <cabdybldr@...> wrote:

Question for Jules. So what are the options? Sustiva caused extreme suicide ideation. The nukes all seemed to cause depression in varying degrees and contributed to congestive heart failure and lipodystrophy issues including belly fat, lipoatrophy and kidney failure (stage 4 due to tenofovir so I won't even consider the new less kidney toxic version because can I really afford to do that experiment?). The protease inhibitors also caused belly fat, etc. All seem to have contributed to diabetes and weight gain to some degree. I am on T replacement and work out with weights and cardio but I can't seem to loose any fat, subQ or visceral. I have worked out my whole life and never had these issues until ART. They have only gotten worse over time. I have no resistance to any of the meds other than epivir and FTC. I am gaining fat, both visceral and subQ. Are there any meds that don't destroy your heart, kidneys, cause diabetes, depression and/or make you fat both subQ and visceral?
Steven H.

Christopher Camp
 

Hi Jules! It was great meeting you at the 9th International Workshop on HIV and Aging.  How can I become more involved?  I was one of the lead trainers with the MidAtlantic AIDS ETC.  I’m poz for over 36 years.


On Oct 6, 2018, at 9:01 PM, Jules Levin via Groups.Io <julev@...> wrote:

As I see it we can’t win. You have to be on ART to sustain viral load <50 and optimize your cd4 - without that your dead. Yet every class of ARTs and every drug has long term adverse effects. You didn’t mention ART neurotoxicity which also is a long term potential bad affect. Yes bad affects on kidney, heart, bone, diabetes, lipids are all potential adverse effects by various drugs. And hiv itself also increases the risk for all these comorbidities. The best one can do is find the least  regimen. One that works best for you. Today integrase inhibitors are very popular, they just came out a few years ago and they looked the least offensive until this weight gain issue was identified. Atazanavir is a PI but also causes elevated bilirubin which studies however find it might be protective of heart disease, but atazanavir has been found associated with bone disease. Darunavir and atazanavir both require ritonavir which increases TAF and TDF levels. Integrase inhibitors can cause CNS side effects but so do all the NNRTIs which mean they affect the brain. The thinking is that integrase is in general the least offensive. If one experiences on an integrase CNS effects they don’t like and excessive weight gain they can switch off. Doravirine is the new NNRTIS just FDA approved, so far it appears to have no affects on lipids, appears to maybe not have the usual CNS side effects that other NNRTIs have. The real problems appear to emerge as one reaches around 65 years old when the aging syndrome affects can kick in, when cognitive impairment might worsen, when osteoporosis and heart disease become a greater concern. Older HIV+ have on average double the prevalence of these comorbidities compared to older HIV-neg. so you have to try to pick a regimen that works best for you. In older age many have to take non ARV medications for various conditions that might interact with ritonavir, another concern. In the end when weighing all this the reason integrase is the most popular and dominates first line recommendations by guidelines is because right now they appear to be safer. Another point is DTG and bictegravir raise creatinine but it’s considered harmless, just an artifact, but if you are tracking your creatinine because you have kidney dysfunction it is difficult to know for sure if your creatinine is going up. In the end all the guidelines have integrase inhibitors as their best first line regimens.


On Oct 6, 2018, at 8:15 PM, Steven Hooper <cabdybldr@...> wrote:

Question for Jules. So what are the options? Sustiva caused extreme suicide ideation. The nukes all seemed to cause depression in varying degrees and contributed to congestive heart failure and lipodystrophy issues including belly fat, lipoatrophy and kidney failure (stage 4 due to tenofovir so I won't even consider the new less kidney toxic version because can I really afford to do that experiment?). The protease inhibitors also caused belly fat, etc. All seem to have contributed to diabetes and weight gain to some degree. I am on T replacement and work out with weights and cardio but I can't seem to loose any fat, subQ or visceral. I have worked out my whole life and never had these issues until ART. They have only gotten worse over time. I have no resistance to any of the meds other than epivir and FTC. I am gaining fat, both visceral and subQ. Are there any meds that don't destroy your heart, kidneys, cause diabetes, depression and/or make you fat both subQ and visceral?
Steven H.

Jules Levin
 

To begin with I suggest you join ATAC and subscribe to FAPP listserve where you can read daily discussions by the most active advocates a u can express your opinions and ideas.



On Oct 7, 2018, at 12:28 AM, Christopher Camp via Groups.Io <skyewarrior21214@...> wrote:

Hi Jules! It was great meeting you at the 9th International Workshop on HIV and Aging.  How can I become more involved?  I was one of the lead trainers with the MidAtlantic AIDS ETC.  I’m poz for over 36 years.


On Oct 6, 2018, at 9:01 PM, Jules Levin via Groups.Io <julev@...> wrote:

As I see it we can’t win. You have to be on ART to sustain viral load <50 and optimize your cd4 - without that your dead. Yet every class of ARTs and every drug has long term adverse effects. You didn’t mention ART neurotoxicity which also is a long term potential bad affect. Yes bad affects on kidney, heart, bone, diabetes, lipids are all potential adverse effects by various drugs. And hiv itself also increases the risk for all these comorbidities. The best one can do is find the least  regimen. One that works best for you. Today integrase inhibitors are very popular, they just came out a few years ago and they looked the least offensive until this weight gain issue was identified. Atazanavir is a PI but also causes elevated bilirubin which studies however find it might be protective of heart disease, but atazanavir has been found associated with bone disease. Darunavir and atazanavir both require ritonavir which increases TAF and TDF levels. Integrase inhibitors can cause CNS side effects but so do all the NNRTIs which mean they affect the brain. The thinking is that integrase is in general the least offensive. If one experiences on an integrase CNS effects they don’t like and excessive weight gain they can switch off. Doravirine is the new NNRTIS just FDA approved, so far it appears to have no affects on lipids, appears to maybe not have the usual CNS side effects that other NNRTIs have. The real problems appear to emerge as one reaches around 65 years old when the aging syndrome affects can kick in, when cognitive impairment might worsen, when osteoporosis and heart disease become a greater concern. Older HIV+ have on average double the prevalence of these comorbidities compared to older HIV-neg. so you have to try to pick a regimen that works best for you. In older age many have to take non ARV medications for various conditions that might interact with ritonavir, another concern. In the end when weighing all this the reason integrase is the most popular and dominates first line recommendations by guidelines is because right now they appear to be safer. Another point is DTG and bictegravir raise creatinine but it’s considered harmless, just an artifact, but if you are tracking your creatinine because you have kidney dysfunction it is difficult to know for sure if your creatinine is going up. In the end all the guidelines have integrase inhibitors as their best first line regimens.


On Oct 6, 2018, at 8:15 PM, Steven Hooper <cabdybldr@...> wrote:

Question for Jules. So what are the options? Sustiva caused extreme suicide ideation. The nukes all seemed to cause depression in varying degrees and contributed to congestive heart failure and lipodystrophy issues including belly fat, lipoatrophy and kidney failure (stage 4 due to tenofovir so I won't even consider the new less kidney toxic version because can I really afford to do that experiment?). The protease inhibitors also caused belly fat, etc. All seem to have contributed to diabetes and weight gain to some degree. I am on T replacement and work out with weights and cardio but I can't seem to loose any fat, subQ or visceral. I have worked out my whole life and never had these issues until ART. They have only gotten worse over time. I have no resistance to any of the meds other than epivir and FTC. I am gaining fat, both visceral and subQ. Are there any meds that don't destroy your heart, kidneys, cause diabetes, depression and/or make you fat both subQ and visceral?
Steven H.

Jules Levin
 

ATAC & FAPP are advocacy HIV policy & treatment groups.

There is an ATAC google discussion group you can joint & become a member too, the same for FAPP, a google discussion group.



For additional information regarding the Federal AIDS Policy Partnership please visit http://federalaidspolicy.org/.
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On Oct 7, 2018, at 6:40 PM, Jules Levin via Groups.Io <julev@...> wrote:

To begin with I suggest you join ATAC and subscribe to FAPP listserve where you can read daily discussions by the most active advocates a u can express your opinions and ideas.



On Oct 7, 2018, at 12:28 AM, Christopher Camp via Groups.Io <skyewarrior21214@...> wrote:

Hi Jules! It was great meeting you at the 9th International Workshop on HIV and Aging.  How can I become more involved?  I was one of the lead trainers with the MidAtlantic AIDS ETC.  I’m poz for over 36 years.


On Oct 6, 2018, at 9:01 PM, Jules Levin via Groups.Io <julev@...> wrote:

As I see it we can’t win. You have to be on ART to sustain viral load <50 and optimize your cd4 - without that your dead. Yet every class of ARTs and every drug has long term adverse effects. You didn’t mention ART neurotoxicity which also is a long term potential bad affect. Yes bad affects on kidney, heart, bone, diabetes, lipids are all potential adverse effects by various drugs. And hiv itself also increases the risk for all these comorbidities. The best one can do is find the least  regimen. One that works best for you. Today integrase inhibitors are very popular, they just came out a few years ago and they looked the least offensive until this weight gain issue was identified. Atazanavir is a PI but also causes elevated bilirubin which studies however find it might be protective of heart disease, but atazanavir has been found associated with bone disease. Darunavir and atazanavir both require ritonavir which increases TAF and TDF levels. Integrase inhibitors can cause CNS side effects but so do all the NNRTIs which mean they affect the brain. The thinking is that integrase is in general the least offensive. If one experiences on an integrase CNS effects they don’t like and excessive weight gain they can switch off. Doravirine is the new NNRTIS just FDA approved, so far it appears to have no affects on lipids, appears to maybe not have the usual CNS side effects that other NNRTIs have. The real problems appear to emerge as one reaches around 65 years old when the aging syndrome affects can kick in, when cognitive impairment might worsen, when osteoporosis and heart disease become a greater concern. Older HIV+ have on average double the prevalence of these comorbidities compared to older HIV-neg. so you have to try to pick a regimen that works best for you. In older age many have to take non ARV medications for various conditions that might interact with ritonavir, another concern. In the end when weighing all this the reason integrase is the most popular and dominates first line recommendations by guidelines is because right now they appear to be safer. Another point is DTG and bictegravir raise creatinine but it’s considered harmless, just an artifact, but if you are tracking your creatinine because you have kidney dysfunction it is difficult to know for sure if your creatinine is going up. In the end all the guidelines have integrase inhibitors as their best first line regimens.


On Oct 6, 2018, at 8:15 PM, Steven Hooper <cabdybldr@...> wrote:

Question for Jules. So what are the options? Sustiva caused extreme suicide ideation. The nukes all seemed to cause depression in varying degrees and contributed to congestive heart failure and lipodystrophy issues including belly fat, lipoatrophy and kidney failure (stage 4 due to tenofovir so I won't even consider the new less kidney toxic version because can I really afford to do that experiment?). The protease inhibitors also caused belly fat, etc. All seem to have contributed to diabetes and weight gain to some degree. I am on T replacement and work out with weights and cardio but I can't seem to loose any fat, subQ or visceral. I have worked out my whole life and never had these issues until ART. They have only gotten worse over time. I have no resistance to any of the meds other than epivir and FTC. I am gaining fat, both visceral and subQ. Are there any meds that don't destroy your heart, kidneys, cause diabetes, depression and/or make you fat both subQ and visceral?
Steven H.