Now that HIV has become a chronic disease that, in best cases, can be relatively easy to manage, you might think that there isn’t much difference when it comes to selecting your antiretroviral medication. However, it’s crucial for a person living with HIV to consider a variety of factors in order to get the maximum outcome with the minimal amount of unnecessary side-effects. Unfortunately, if you don’t know the right questions to ask, your doctor could make the wrong decision for you.
To help figure out what meds will work best for you, we asked nurse practitioner Eric Klappolz, an HIV specialist in Dallas, Texas, who treats a variety of people living with HIV.
“Most people might just buy into the one-pill once-a-day and that is it, but there are plenty of factors that someone should consider when choosing their HIV medication,” says Klappholz. “Your job, your schedule, you lifestyle, these all factor into determining which medication will work best.”
Klappholz says that he regularly treats new patients who elect to switch meds because they didn’t know enough when they first started taking treatment. New patients can often be so fixated on their diagnosis that they do not think to ask their doctor the right questions. Not only that, but patients can be reticent to share some of their behaviors that could help their doctor make the right choice. Once a person with HIV has successfully achieved viral suppression and the emotional component of treatment has subsided, he or she is in a place where they can better assess if there is a better medication to fit his or her needs.
Klappholz tells us which medications would correspond best with several common lifestyle factors.
If you have an unusual schedule
Maybe you travel to different time zones often or, you work alternating or swing shifts. An unusual schedule can make it difficult to comply with a strict dosage schedule. For some medications, missing even a dose or two here and there can be quite the problem. “I would typically prescribe Prezcobix and Truvada for this patient, just because the Prezcobix is the most forgiving if you are likely to miss dosages. The chances of building a resistance is low, and even if you do, it doesn’t eliminate a lot of other options later on,” says Klappholz.
If you’re “otherwise healthy”
If you are not dealing with any coinfections, you don’t smoke or drink heavily, and you aren’t overweight, you may be considered what doctors call “otherwise healthy.” This just means that you aren’t at any significant risk for cardiovascular disease, which makes you the perfect candidate for Triumeq. “Right now, I am putting my new patients on Triumeq when I can, because there is no other interactions with other medications and it just seems to me to be the best thing out there.”
If you can be considered “overweight”
Although Triumeq is an excellent drug choice for some, it does come with certain cardiovascular risks. Therefore, Klappholz doesn’t recommend that patients who are overweight take this drug. Instead, he says a Tenofivir-based medication, such as Stribild or Genvoya, is the best choice.
If you also have hepatitis C
More than 20 percent of people living with HIV are also living with hepatitis C. An HIV/HCV comorbidity more than triples a person’s risk for multiple liver issues, so it is important to select the right medication to best treat both diseases while minimizing any unnecessary risks. New medications are making hep C easier to treat, as well. “If one of my patients also has HCV, Complera is the safest bet during the duration of the person’s HCV treatment. Once he or she is determined to be HCV-negative, a patient can then re-evaluate their HIV medication about three to six months afterwards.
If you’re a heavy drinker or recreational drug user
Much like people with unusual schedules, a person who engages in heavy alcohol or recreational drug use runs the risk of missing their daily dose by time specified or altogether. Likewise, the same suggestion of Prescobix and Truvada is recommended because, once again, it is the most forgiving when it comes to drug resistance for patients who might miss doses.
If you’re a long-time user of Atripla
Atripla was once the go-to for people with HIV, but the arrival of new medications such as Stribild, Complera, Truimeq, and Genvoya has knocked the popular drug down a notch. Now that Atripla is no longer a first-line medication, Klappholz recommends that his patients switch to a newer medication that provides all of the benefits with fewer side-effects. “I will often hear, ‘But it’s working and I don’t have any bad side-effects, so why change?’” Klappolz says. “But even patients who claim to no longer have side-effects from Atripla usually come back in a month or two saying that they are so happy with the switch.”
If you smoke
A person who smokes should avoid Triumeq in order to avoid any additional increase in cardiovascular risks. Unfortunately, many patients will try and minimize their tobacco use when speaking with their doctor. Even if you smoke occasionally, let your doctor know. If you have yet to completely give up smoking, Klappholz says that Stribild or Genvoya are most likely the best options for you.
Our new expert on-call is nurse practitioner Eric Klappholz, an HIV specialist in Dallas, Texas, who treats people living with HIV.