Hi Dr. Joel! You had recommended a switch from TIvicay to Isentress or Prezcobix due to continued insomnia. Of the two which is "better?" or newer with fewer side effects? Would Isentress be better based on it being developed into a long term injectable in the near future? One concern I had was a review about a user who reported lipodystrophy from 5 yrs of Raltegravir. Is this possible? I thought these newer drugs had a very small incidence of Lypo. Thank you for all you do ! A true hero!
There’s no long-term injectable version of Isentress coming. There’s a once-daily formulation (two tabs once a day plus the nucleoside combination), and there’s a long-acting injectable version of cabotegravir, a different integrase inhibitor. None of the integrase inhibitors cause lipodystrophy.
Of the two I mentioned, Isentress has the advantage of being an integrase inhibitor with an excellent safety and tolerability and few drug interactions. The disadvantage is that for now you’ll be taking 3 pills per day in 2 different doses. With Prezcobix you’d be on a once-daily regimen with a higher barrier to resistance than Isentress. However, the resistance barrier should only be a consideration if you’re likely to miss doses. Prezcobix is more likely to cause GI side effects than Isentress, and it also has more drug interactions.
