After one month on Stribild, some thoughts and links.


Adherence. This is almost ridiculously easy with just one pill a day, taken with lunch. Like a vitamin. So far I’m at 100%--very early days, I know. Read a study recently, though, which questions the (financial) wisdom of co-formulations. “The development of single tablet regimens may meet a demand from people living with HIV and clinicians for treatments that are more convenient and easier to take, but can the high price tags be justified by better patient outcomes?”


Side-Effects. Terrible nausea, really awful, for the first two or three days; mild diarrhea on the first day. And that was it for GI protestations. But getting used to the shenanigans of cobicistat (one of the four medications in Stribild): that took about ten days. Had to alter, lower the doses of some other meds. As one friend put it: “Welcome to the trials and tribulations of Cytochrome P450 3A4.”


Cobicistat “is a potent inhibitor of cytochrome P450 3A enzymes, including the important CYP3A4 subtype.” “By combining cobicistat with elvitegravir, higher concentrations of the latter are achieved in the body with lower dosing, theoretically enhancing elvitegravir’s viral suppression while diminishing its adverse side-effects.”


Iowa. Once upon a time I used to read novels and watch movies simply because they had gay characters in them. So it was that I had seen Boys Life 2, a compilation of four short films, in the spring of 1997. One of these, “Alkali, Iowa,” stood out for me then; I saw it multiple times at the Kendall Square Cinema in Cambridge. I still think it’s a superb gay “short.” When a long story by Annie Proulx called “Brokeback Mountain” was published in The New Yorker, in the fall of 1997, I remembered that short film from earlier that year...


Seventeen minutes long, written and directed by Mark Christopher, it’s available on YouTube, check it out: