To Tenofovir or Not To Tenofovir?

I just had my quarterly consultation with my doctor and I asked about the "new" Tenofovir that recently made some news about being better and less toxic.

Sure, advancement in medicine has made the "new" Tenofovir less toxic compared to Combivir, however, it is not without consequences, cost being one of it.

In Malaysia, newly on ARV are now given Tenofovir + a NNRTI. Both are once a day pill (anyone on Tenofovir care to share more? I know some people who previously dropped me emails have begun on Tenofovir, any thing you noticed?)

So I asked my doctor, what if I switched?
The answer is this: Yes there is a possibility of switching to Tenofovir, however, the government will not be paying as this will be considered a second-line as opposed to first-line med currently being fully paid for by the government. The cost of Tenofovir is roughly MYR200+ a month. Those who are newly on ARV on Tenofovir can switch to Combivir if it is found to be not suitable. However, those of us who are already on Combivir who opt for Tenofovir, may or may not be able to switch back in the future. Changing medicine is not as simple as changing clothes. The one reason to ditch Combivir for Tenofovir is when Combivir is causing problems to the blood cells. 

 Makes sense.
So I am still back on my Combivir+Efavirenz combo. It's working well and fine.

To put things into perspective for foreign readers, the Malaysian government fully subsidize our (citizens) first-line ARVs, dispensable at all government clinics and hospitals. The government also fully subsidized everything else, from lab fees, tests, consultations to hospitalization. In the course of my HIV medication, I have only paid MYR 2 (one ringgit being first time ever registration and another one ringgit being hospital admission fee).

Indirectly, I am not complaining because essentially, these are my tax monies.

On my last test which was in October, both CD4 and CD4% suffered some decline - something that flagged my doctor's attention, and she immediately ordered and scheduled me for another complete FBC, CD4, VL and others in January.






Comments

  1. Anonymous10 January 2016 at 23:52

    Hmmm..i came across your blog and read this. Tenofovir is fully subsidized by the goverment.

    Lemme summarize how i took this:
    1. In 2013, i started in UMMC with the normal blood tests, once my cd4 declines, doctor suggest me to start ARV meds

    2.He suggested Combivir+Efa since its free, but i told him i read online articles, tenofovir is free. The reason why i prefer to start with this is the easier once a day pill, less toxicity, less chance of fat lipoatrophy that combivir causes. Then he told me Tenofovir have to pay like what you said because UMMC is a semi gov hospital. He say it will be free in the future but in the meantime not yet.

    3. After thinking about it, I decided to transfer to Sg Buloh Hosp, since UMMC charges for viral load/Cd4 which is still costly after susbsidize (few hundred) since im a student. The doc wrote me a letter then off i go to Sg Buloh

    4. Now, its been nearly 2 years im on Tenofovir+Efa which is free in goverment hospital. I heard recently though, UMMC gives tenofovir for free now. But still not going back there because lazy to do all over again plus I save my lab tests money as compared to my transportation money :)

    So sticking to your combo is a good thing too, if in the future problem arises, you still have a backup bullet to combat this disease.About the side effects, mostly every night i have mild night sweats and feeling of high/drunk, but I try to work around it since its a newer type of medication, and the latest type of ARV has still no generic in Malaysia. Malaysians should really adhere to the medications as we are super lucky that the meds is free. Look at singapore, no subsidy and some people really went poor cos of this.

    Anyways, hope this help your readers :)

    ReplyDelete
    Replies
    1. Anonymous13 January 2016 at 14:02

      Thanks for sharing.

      Yes, tenofovir is free, but as a first line only. In my case, if I switch, then it will be considered second-line and the cost to me is about RM200 or so. Nowadays the govt hospitals print the cost of the medicine on the label. My current Efavirenz is also a generic that's OEM printed with KERAJAAN MALAYSIA. No idea who the supplier/manufacturer is.

      Tenofovir is proven to be less toxic than Combivir, which is why it is now the preferred cocktail for those newly on med.

      Yes I agree UMMC is not really a "recommended" place to go. It's just horrible and need to pay.

      Delete
    2. Anonymous17 January 2016 at 22:06

      Oh, in my understanding and the articles i read online, I remember my doctor said before if you change still within first line meds due to personal choice like missing doses or side effect, then its still counted as first line. Unless you face resistant while on first line meds, then you have to consider taking others(which in your case will be tenofovir) which then will be counted as second line treatment. Maybe you can confirm with another doctor or counselor.

      I personally dont like combivir cos many stories online i read where patients have face lots of fat redistribution in face, arms, legs in which many friends friends and family were shock to see the changes. I heard the changes will take around few years to see.

      Yeah UMMC, you still have to pay minimum RM 5-15 per MONTH when collectings meds at pharmacy. Thats why its not a fully goverment hosp. One appointment at HIV specialist RM 30. normal blood tests few ringgit, CD4 test after subsidy RM 110, viral load not sure cos i left to HSB after that. Can you imagine that adds up over long time, as compared to now i at HSB which is totally free? I just fork out transport money to there 4 times a year, plus RM 5 for poslajuing the meds to me every 2 months (Have you heard of it? its call Ubat melalui pos, which is quite useful then going to the pharmacy every month to collect)

      Do you have a contact in which we can communicate? Its kinda lonely being the only one i known in my life. Its nice to have a friend to chat sometimes about this topic and challenges faced :)

      Delete
  2. Anonymous18 January 2016 at 23:35

    Really? I didn't know that one could change without incurring the costs. As a matter of fact, it hasn't really cause me any problems in the last 2 years plus I've been on combivir, hopefully it'll stay that way for a long time haha!

    Thanks for sharing the costs breakdown in UM, I'll share it soon.


    For me, fats are the least of my problems. Rather, I've never been fat all my life and is rather lean so I am more or less stay the same.

    I'm reachable by email or Twitter :)
    That's a sure way to get me while being anonymous hahah!

    ReplyDelete

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