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Approximately 8 years ago, when I was first diagnosed with HIV, we were trying to figure out exactly what other health concerns I would have. After I started my first 3-drug regimen—rilpivirine/emtricitabine/tenofovir disoproxil fumarate—I was experiencing issues with gout along with the high blood pressure. Unfortunately, I’m overweight, I smoked cigarettes, and I was drinking a little bit. I’m not sure if my healthcare team saw problems with my kidneys at first, but over time, my kidney function worsened.
I switched to a second 3-drug regimen—rilpivirine/emtricitabine/tenofovir alafenamide—and I did really well on that, HIV-wise. I was undetectable on these medications and stayed on them for approximately 4 years. But maybe about 2 or 3 years ago, my doctor was able to see that my kidney function was continuing to worsen. The biggest concern that I had was that my kidneys would pose a bigger problem to me than anything else.
My doctor suggested 2 things: that I see a kidney doctor, and that we think about moving to a 2-drug antiretroviral therapy (ART) regimen—dolutegravir/rilpivirine.
Having a Good Relationship With Your Doctor Is Key
I definitely had some hesitation in switching from a 3-drug regimen to a 2-drug regimen. One of my main concerns was that I didn’t want to be the test person. I have a lot of responsibilities in my personal life and with my job, and I need to make sure that I am in the best health possible.
I have a really good relationship with my doctor, and before switching to this 2-drug regimen, I asked him a million and one questions.
My first question was, of course, “Aren’t 3 drugs better than 2?” That seemed obvious to me.
Some of the other questions I asked my doctor before switching to the new regimen were: “What are the side effects?” “How would I tolerate it?” “Would it cause any problems in the future?”
I’m an information technology guy by day, but I consider myself my own doctor at night—this sometimes is good and sometimes not. I kept looking up information on the new regimen until I was comfortable with the switch.
I also asked my nephrologist what she thought about the 3-drug vs the 2-drug regimen. I tried to play them against each other just to be sure that the information that I was receiving was the same. I found that what they were telling me was consistent: This 2-drug regimen would be better for my kidneys.
What I’ve Learned
Regarding the HIV, my new regimen handled that very well and I was able to remain undetectable. I was really concerned, though, about what the new medications would do to the other parts of my body—specifically my kidneys. But moving from 3 drugs to 2 drugs actually helped my kidneys. They were able to stabilize my kidneys at their current level of functioning.
After switching, my nephrologist said, “Your kidneys are stable.” It didn’t improve anymore, but it definitely did not decrease. So I said to myself, “This is working!”
I have learned to trust my HIV physician; outside of my girlfriend, he’s the only person who knows about my HIV status and my kidney problems. It’s already tough enough to deal with something like HIV, which you want to keep private because you don’t know how you’ll be looked at. But then to have other medical issues along the way—no one wants to put that burden onto family members.
One of the biggest takeaways is to take an active role in your own health: Understand why your doctors are prescribing what they are, and ask what issues may arise in taking a new medicine. Weigh those risks and benefits. Being an informed person helps you be sure that you are getting the best care possible.
Do you have patients who have switched to 2-drug ART regimens? How did you prepare them? Join the discussion by posting a comment.