February 21, 2012

February 21, 2012
Tenofovir Linked to Kidney Damage

Welcome to another day in my life. Today is Tuesday and I hope you had a safe and great three day holiday weekend. It was another busy weekend for Dab the AIDS Bear and me. During the down time, I had a great time with my partner Todd.

I always hate to be the bearer of bad news but it seems like we have found out one of our HIV medications can cause kidney damage.

I do not believe there are any studies that indicate that taking meds on alternate schedules discussed on this list is effective or save in the general population.

Let me make myself clear: I am not questioning the success of the individuals who have shared.

Yes, some drugs have longer half lives than others (meaning they tend to stay at significant levels in the blood stream for a longer time after you take them.) But just because one of these alternate scheduling strategies works for some individuals does not mean it will work for you. Moreover, the process of finding out by definition involves risk.

To understand this, one has to understand the bigger picture. We all know that how a particular drug works in an individual varies, affected by many factors. Those factors can include things like age, weight, sex, diet, and most definitely genetics. When a drug is tested for approval, the goal is to find a dose that is highly effective in most people under real world conditions. Sometimes the desire to use a higher dose to create a higher margin of error is challenged by a need to minimize side effects. A happy medium must be found, but fortunately this has been less problematic with newer anti-virals.

In other words, although it's know that blood levels will vary widely from individual to individual, the goal is to have a dose that is effective even in folks whose individual situation yields a lower blood level. The situation includes the factors I listed plus the day to day variations in those factors, including adherence.

So, if you try this experiment (I sure would not ever without doing so in collaboration with my provider,) there will be some risk (I do not think anyone can say how much) that you will be a person who ends up with lower drug levels; if those levels are sub-optimal you could develop resistance to that drug or class of drugs.

One of the advantages of having drugs with long half lives is that they are adherence forgiving. In other words, they decrease the likelihood of failure (resistance) with occasional irregular dosing. So, if your adherence is not perfect, you could end up with suboptimal dosing at times which entails the same risk.

I congratulate the folks who have been able to make this work. My adherence is quite good, but not perfect, so this would not be an avenue I personally would pursue unless side effects became extreme or I was forced by some system failure to temporarily adopt it while waiting for access to meds.

So now you have the latest information I have heard so you can make an informed decision.

Hope you have a great Tuesday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab