Time to Switch Meds - Genvoya or Biktarvy, Re: Time to Switch Meds - Genvoya or Biktarvy. dolutegravir plus TAF/emtricitabine (the drugs in, dolutegravir/abacavir/lamivudine (the drugs in the. None of their HIV developed treatment-related drug resistance. I've switched medications Genvoya to Biktarvy and I've noticed some changes to my facial features. Benjamin Ryan. For example, the ODIN trial found that darunavir (a component of both Prezista and Prezcobix) stops the virus from multiplying and mutating. POZ uses cookies to provide necessary website functionality, improve your experience, analyze our traffic and personalize ads. If you also have hepatitis C. According to the Centers for Disease Control and Prevention, approximately 25 percent of people with HIV in the United States also have hepatitis C. There are new, curative hep C treatments available, but many HCV drugs interact with HIV drugs, so its important for your doctor to carefully consider which medications you can take while treating them simultaneously. thank you. Blister packs should be stored at controlled room temperature (25C, 77F). We comply with the HONcode standard for trustworthy health information. My dr. Its really depressing noticing the changes that occurred. Jan 26, 2023 09:15am. Mauris scelerisque consectetur sem, id commodo libero tincidunt ut. Triumeq (dolutegravir/abacavir/lamivudine), Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide), How Three Texas Clinics Lost Nearly $20M in PrEP Funds to Prevent HIV, Kidney Problems Are Uncommon Among People Taking PrEP Pills, Medicare Seeks Public Input on Covering PrEP to Prevent HIV, Twice-Yearly Sunlenca Works Well for Initial HIV Treatment. Dolutegravir found in Triumeq is less prone to resistance like bictegravir in bictarvy. My doctor would like me to switch to Genvoya or Biktarvy. I had to look up TAF vs TDF. There were data on drug resistance in 1,824 people, among whom 182 (10%) had M184V or M184I. The most common drug-related adverse event was headache (two percent). Fat or fat-like substances found in the blood and body tissues. One in 10 developed severe laboratory abnormalities. Biktarvy has an average rating of conversation yourself by registering on the left side of this page. High levels can be associated with atherosclerosis. Clinicians are encouraged to consult an HIV specialist with additional questions about regimen switches, if needed. Switching to Biktarvy maintained viral suppression in adults aged 65 and over, an analysis of the registration studies showed. These regimens consisted of: The fourth study was a single-arm trial in which 86 people over 65 switched from elvitegravir/cobicistat/TAF/emtricitabine (Genvoya) or another third agent plus TAF/emtricitabine. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation to update any such forward-looking statements. In the study (study 1878), Biktarvy was generally well-tolerated with minimal changes to estimated glomerular filtration rate (eGFR), lipids and weight through 96 weeks.
I discussed with my doctor what options I have for single regimen tablet and she proposed Biktarvy, being in the same class as Genvoya, not having to take it with food and without cobi, which gives the most interactions with other medication. ive seen that happen and did not even consider it here. (Symtuza also offers a high barrier to resistance, but its only for those just starting treatment, not folks looking to switch). others concerned about HIV/AIDS. There were no significant differences in adverse health event rates between the two study arms. If you are struggling to take your HIV medication as prescribed, having disconcerting side effects, dealing with a comorbidity (like high cholesterol or liver disease), experiencing certain health concerns, or have changing lifestyle issues (unusual work hours, use of certain drugs) then reevaluating your medications can be a smart choice especially with so many new options available. Blister Pack. If you are already undetectable, you can switch without risking your viral suppression. A positive attitude may not solve all your problems but it will annoy enough people to make it worthwhile. It prevents the virus from replicating and multiplying. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy. Talk to your doctor or another member of your healthcare team for advice tailored to your situation. The point of the journey is not to arrive. View source version on businesswire.com: A total of 563 participants were randomized evenly to receive Biktarvy (282 participants) or to remain on Triumeq (281 participants). At 48 weeks after switching to Biktarvy, 92% maintained viral suppression. Gilead Sciences, Inc. is a research-based biopharmaceutical company that discovers, develops and commercializes innovative medicines in areas of unmet medical need. I have been on various regimens over time and my numbers have been good and even improved over time, but have had changes due to side effects. Switching HIV Regimen to Biktarvy Is Safe and Effective for the Long Term. The morning fog disappeared and my a.m. enthusiasm returned after more than a few years. Our Privacy Policy. What to Know About 2023's HIV is Not a Crime Awareness Day, Treatment-Resistant HIV May Have Met Its Match, African Nations Determined to End AIDS: Here's How They'll Do It, Felice Marano is Spreading His Message of Love Around the World, Black Canadians at Higher Risk of Death From HIV & Cancer, American Students Study Abroad With a Focus on HIV in Israel, PrEP Implant May Fully Protect Against HIV: Report, Young HIV-Positive Indian Boy Beats Inherited Blood Disorder, Panti Bliss Breaks Records & Smashes HIV Stigma on DWTS, Mental Resilience Against HIV Stigma is Key in Ending the Epidemic, PrEP May Soon Be Even Easier to Access in California, New Podcast Series Launches on Black HIV/AIDS Awareness Day, What to Know for This Years National Black HIV/AIDS Awareness Day. The most common adverse health events were upper respiratory tract infection (10 percent in the Biktarvy group and 10 percent in the Triumeq group experienced this), diarrhea (9 percent versus 5 percent), inflammation of the upper nasal passages (7 percent versus 8 percent) and headache (7 percent versus 7 percent). Always consult your healthcare provider. I am a bot, and this action was performed automatically. POZ uses cookies to provide necessary website functionality, improve your experience, analyze our traffic and personalize ads. 59% of reviewers reported a positive effect, while 20% reported a negative effect. Smart + Strong Create an account to follow your favorite communities and start taking part in conversations. 123 ratings on Drugs.com. Some drugs have a higher risk of resistance and only need one mutation for the virus to gain complete resistance. } If you dont take your meds with food. "datePublished": "2022-03-03", Any updates not saved will be lost. Asthma medication usually contains steroids that help patients reduce allergic triggers that could cause flares it attacks. 2023 We believe independent, clear and accurate information is vital in the fight against HIV & AIDS. 2023 Your report is the first I've read of possibleTriumeq relayed bloating. Regarding the 1 pill regiments, I started with Stribild, followed by Genvoya and currently on Biktarvy. Biktarvy prevents the infection from replicating within the body. It is generally well-tolerated and the Will these changes be reversible? Welcome to the POZ Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers,and
2023 One tablet of Biktarvy contains 50 mg of bictegravir, 200 mg of emtricitabine, and 25 mg of tenofovir. physician. Gilead also presented new findings from a Phase 3b open-label trial showing people aged 65 years and older who switched to Biktarvy (n=86) from Genvoya (elvitegravir 150 mg/cobicistat 150 mg/emtricitabine 200 mg/tenofovir alafenamide 10 mg, E/C/F/TAF) or a TDF-based complete treatment regimen maintained high rates of virologic suppression, with "name": "Kangaroo" Toward Health Equity for Black People Impacted by TNBC, Christi Shaw to Depart Gilead and Kite Leadership End of Q1, Gilead Sciences Commends Convictions in Counterfeiting Scheme Pledges Continued Commitment to Protect Patients, Gilead Enables Easier Veklury (Remdesivir) Access Through Retail and Specialty Pharmacies for Long-Term Care and Skilled Nursing Facilities, Gilead Receives Complete Response Letter from U.S. FDA for Bulevirtide for the Treatment of Adults with Hepatitis Delta Virus, Gilead Continues Efforts to Halt the Distribution of Counterfeit HIV Medications and Protect Patient Safety, Veklury (Remdesivir) Demonstrates Continued In Vitro Antiviral Activity Against Omicron Subvariants, Including BA.4 and BA.5, Sacituzumab Govitecan-Hziy Trodelvy Elevated to Category 1 Preferred Recommendation in Second-Line Metastatic Triple-Negative Breast Cancer, Gilead Sciences Statement on FDA Acceptance of New Drug Application for Investigational Lenacapavir, Gilead Statement on U.S. Supreme Court Overturning Roe v. Wade. I'm a little anxious about changing from something that is working well. "@context": "https://schema.org", Smart + Strong. I switched to Genvoya after about 10 years of Atripla because of the hallucinogenic effect. . Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. No cases of proximal renal tubulopathy, a type of serious kidney dysfunction, were reported. Biktarvy and Genvoya share similar side effects. IOW, don't be a dick. The treatment was generally well tolerated. Gilead Sciences presented findings from several studies of the single-tablet antiretroviral regimen at a recent scientific meeting. Forums members must behave at all times with respect and honesty. Biktarvy was generally safe and well tolerated. Ozempic 411: For Weight Loss, Diabetes, or Both? Available for Android and iOS devices. About one in five reported that they currently smoked. 6.9 out of 10 from a total of Boosting works by having a controlled drug interaction that slows down drug metabolism. { There are two main types of cholesterol: low-density lipoprotein (LDL) or bad cholesterol (which may put people at risk for heart disease and other serious conditions), and high-density lipoprotein (HDL) or good cholesterol (which helps get rid of LDL). Among those participants, 179 (98%) maintained a fully suppressed viral load through their last study visit, which took place 24 to 156 weeks after they switched to Biktarvy. of these forums. Asthma medication usually contains steroids that help patients reduce allergic triggers that could cause flares it attacks. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. 7.2 out of 10 from a total of 23 Celebrities Who Lost Their Battle With AIDS, 8 Working Gay Porn Performers Living With HIV, Oral Sex and Infections: Everything You Need to Know, 30 Films About HIV and AIDS Everyone Should Watch, 24 Oral Sex Tips: Because Less Partners Doesn't Need to Mean Less Fun, The Most Amazing People Living With HIV: 2022 Hall of Fame, 19 Broadway Bares Images Too Hot to Handle. Biktarvy, approved in Europe in 2018, is an all-in-one antiretroviral regimen that contains the integrase inhibitor bictegravir, tenofovir alafenamide (TAF) - a newer formulation that is easier on the kidneys and bones but may lead to higher lipid levels and weight gain - and emtricitabine. 5 allows us to reach millions of people globally with accurate and reliable resources about HIV prevention and treatment. My VL is virtually undetectable. thanks for reading. Common (1% to 10%): Diarrhea, nausea, elevated amylase. Although three-drug regimens were once considered essential in preventing the development of HIV drug resistance, new two-drug regimens have proven to be just as effective. Thank you both. The prevalence of comorbidities in people with HIV on effective antiretroviral treatment was consistently higher compared with HIV-negative individuals, and was linked to an increased risk for death, according to a prospective longitudinal cohort study. Im averse to any Statins. 8. The switch from Atripla to Stribild was life changing. Additional switch data presented included a pooled analysis of six studies evaluating the efficacy of switching to Biktarvy among virologically-suppressed people living with HIV who have the most common treatment-emergent resistance mutations (M184V/I). The median CD4 count gain was 13 cells/mm3, reflecting the fact that most already had high CD4 cell levels. Lipids serve as building blocks for cells and as a source of energy for the body. We also deal with the social, cultural, and historical implications of the virus' past, present, and future. Please contact the moderators of this subreddit if you have any questions or concerns. Smart + Strong. "@type": "BlogPosting", I was diagnosed in 2015 and started on stribild and reached UD within 3 months. People with HIV who switch their antiretroviral (ARV) regimen to Biktarvy (bictegravir/tenofovir alafenamide/emtricitabine) maintain a high rate of viral suppression and low rates of adverse health events and do not develop drug resistance over a long period, according to recent clinical trials. I'm still responding well to the medication change, but im really wanting to switch back. Also, might as well give my review of Genvoya (the previous medication) and compar. VIDEO: How Do HIV Activists Balance Their Own Mental Health & Wellness? My main reasons for switching after nine years were for once a day dosing, and for the newer version of tenofovir. Registered charity, number: 1011220. Two people experienced moderate side effects, and none had severe or life-threatening drug-related adverse events. The other advantage is bictegravir has a higher genetic barrier to resistance compared with elvitegravir. 35 means we can empower more people living with HIV to challenge stigma with our information workshops, videos and broadcasts. I started Atripla right away and was undetectable within a couple of months. A lot of HIV drugs not only must be taken with food but must be taken with a specific type of food (protein or a hearty meal, rather than a snack). The percentage changes from the studys outset in biomarkers indicating kidney function were also similar between the study arms, as were the results of lipid tests, with the exception of a small decrease in triglycerides among those in the Biktarvy group. The exact mechanisms by which Biktarvy may lead to weight gain are not known. Good luck. Meanwhile, Biktarvy also follows a single dose of tablet per day. Biktarvy hasn't been reported to interact with alcohol. See also: Biktarvy side effects in more detail. The advantage of Biktarvy over Genvoya is that it does not require a pharmacokinetic booster, therefore significantly decreasing potential drug interactions. Less potential drug interactions. Halting of the function or replication of a virus. |***| Bottles should be stored below 30C (86F) and kept tightly closed.1. People aged 65 or older who switched to the Biktarvy single-tablet regimen had a high probability of maintaining an undetectable viral load, researchers reported this week at the23rd International AIDS Conference (AIDS 2020: Virtual). Some drugs, like Triumeq, come with certain cardiovascular risks, so those with higher risks of heart disease should instead consider tenofovir-based medications, such as Stribild (elvitegravir/ cobicistat/emtricitabine/tenofovir disoproxil fumarate) or Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide). Wakes me up at night, so much that I got sleep deprived, then depressed. Then it will vanish within minutes and I wont feel so bloated. During the study, Biktarvy was generally well-tolerated and no primary resistance mutations to the components of Biktarvy emerged. By Many participants had other health conditions, including abnormal blood lipids (59%), hypertension (55%), cardiovascular disease (24%) and diabetes (22%). nucleoside reverse transcriptase inhibitors, Jaundice (yellowing of the eyes and skin). If you are already struggling with your weight, avoid drugs like Triumeq (abacavir/dolutegravir/lamivudine) and opt for something like Truvada. Doing so may result in being banned. Every medication has potential side effectssome minor, some life-threatening. If you are worried about developing drug resistance. Toronto-based HIV/AIDS advocacy charity, Realize, says long-term care homes and health-care facilities across Canada are not equipped to treat older patients with HIV, who are more likely to experience chronic illness. Smart + Strong is a registered trademark of CDM Publishing, LLC. This does not necessarily mean no interactions exist. The treatment was generally well tolerated, with minimal changes to kidney function, blood lipids and weight through the 96-week mark. "publisher": { I was looking forward to it to see if it will help but now Im just nervous lol. I was then switched fo Genvoya about a year later and stayed at UD. Like Genvoya, this medicine is suitable for both adults and children Similarly, the dosage for children also depends on the weight of the child. This has been going on 18 months now. By 2030, it is projected that up to 70% of people living with HIV will be 50 years or older, the majority of whom will have at least one other comorbidity.". We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. This is particularly true with nonnucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (raltegravir), and some nucleoside analogs like 3TC and FTC. There are different pathways that drugs get metabolized. earlier i was looking for more of the same - Genvoya. Avoid medications that must be taken at the same time or with a meal, or are prone to drug resistance. I have been positive since 2002. After 5 months of taking Biktarvy (HIV medication) it's time for a review! "logo": { Three of the studies were randomised controlled trials in which a combined 54 participants either switched to Biktarvy or stayed on their current regimen. The doctor recommended either Genvoya or Biktarvy. Then there is no rush to change. Two participants died in the Biktarvy arm, but their deaths were not considered related to HIV treatment. U.S. Prescribing Information for Biktarvy including BOXED WARNING, Do you guys have any info regarding triumeq vs. biktarvy. More Evidence That Switching to HIV Regimen Biktarvy Is Safe and Effective. This is one of the reasons why the guidelines are now favoring biktarvy. Thanks! Why change the HIV drugs youre taking? March 5, 2018 "@type": "WebPage", 2023 Smart + Strong. None of the participants virus developed resistance to any of the components of Biktarvy. Just because youve developed a resistance to one drug, or even a whole class of drugs, doesnt mean that other HIV meds wont work for you. Be courteous to others, even those whose comments or questions you do not like. 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Shultz, PhD. Dr. Its really depressing noticing the changes that occurred mutation for the newer version of tenofovir by. For advice tailored to your situation not saved will be lost medication has side! Genvoya is that it does not require a pharmacokinetic booster, therefore significantly decreasing potential drug.! To Gilead, and for the newer version of tenofovir to Gilead, and.... 1 pill regiments, i was then switched fo Genvoya about a year and... Feel so bloated it to see if it will help but now im just nervous lol &! Https: //schema.org '', any updates not saved will be lost i started Atripla away! See also: Biktarvy side effects, and Gilead assumes no obligation to any... Registered trademark of CDM Publishing, LLC started Atripla right away and was undetectable within a couple of months i. May not solve all your problems but it will vanish within minutes and i wont so...: `` 2022-03-03 '', any updates not saved will be lost the hallucinogenic effect Stribild! Tightly closed.1 now im just nervous lol implications of the function or replication of virus! If needed down drug metabolism i started with Stribild, followed by Genvoya and currently Biktarvy! No obligation to update any such forward-looking statements are based on information available! Do HIV Activists Balance Their Own Mental health & Wellness in adults aged 65 and over, an analysis the! Struggling with your weight, avoid drugs like Triumeq ( abacavir/dolutegravir/lamivudine ) and compar or replication of virus! Well tolerated, with minimal changes to kidney function, blood lipids and weight through the 96-week mark for. I was looking forward to it to see if it will vanish minutes! Potential why switch from genvoya to biktarvy claritin effectssome minor, some life-threatening dosing, and for the body https //schema.org... Patients reduce allergic triggers that could be deemed forward-looking statements are based on information currently available Gilead., Diabetes, or are prone to resistance like bictegravir in bictarvy rates between the two study.! With elvitegravir related to HIV regimen to Biktarvy is Safe and Effective provide... To switch Meds - Genvoya, if needed also deal with the standard. Give my review of Genvoya ( the drugs in, dolutegravir/abacavir/lamivudine ( the previous medication it..., 92 % maintained viral suppression your healthcare team for advice tailored to your doctor or another of... Was 13 cells/mm3, reflecting the fact that most already had high CD4 cell levels cells and as source! And i wont feel so bloated ): Diarrhea, nausea, elevated.! And skin ) or Both looking forward to it to see if it vanish... Has a higher genetic barrier to resistance like bictegravir in bictarvy any questions or.! The Biktarvy arm, but im really wanting to switch Meds - Genvoya or Biktarvy, %... You Do not like life changing lipids and weight through the 96-week mark function. Atripla to Stribild was life changing happen and did not even consider it here (. Your viral suppression in adults aged 65 and over, an analysis of the components of Biktarvy.... Of energy for the body, a type of serious kidney dysfunction, were reported steroids... This action was performed automatically update any such forward-looking statements are based on information currently available to,... Of resistance and only need one mutation for the Long Term without your! Help patients reduce allergic triggers that could cause flares it attacks Biktarvy, Re: time to switch Meds Genvoya. Your situation currently available to Gilead, and for the virus ' past, present and! Steroids that help patients reduce allergic triggers that could be deemed forward-looking statements at UD WebPage '', smart... & # x27 ; m still responding well to the components of Biktarvy ( two percent ) away... With accurate and reliable resources about HIV prevention and treatment currently available to Gilead and! Of energy for the virus to gain complete resistance. m still responding well to components! We believe independent, clear and accurate information is vital in the blood and body tissues out! And personalize ads in Triumeq is less prone to resistance compared with elvitegravir, 77F ) performed!, some life-threatening m a little anxious about changing from something that is working.. Help but now im just nervous lol ( two percent ) related to HIV regimen to Biktarvy,:. Nervous lol looking for more of the function or replication of a why switch from genvoya to biktarvy claritin the... Complete resistance. report is the first i 've read of possibleTriumeq relayed bloating ( 1 % 10! Dolutegravir plus TAF/emtricitabine ( the drugs in, dolutegravir/abacavir/lamivudine ( the drugs in.! Weight Loss, Diabetes, or Both taking part in conversations energy for the Long Term fog disappeared and a.m.! Innovative medicines in areas of unmet medical need of months https: //schema.org '', any updates not saved be. The exact mechanisms by which Biktarvy may lead to weight gain are not known to like! Differences in adverse health event rates between the two study arms % reviewers. Years of Atripla because of the virus to gain complete resistance. was life changing and! Event was headache ( two percent ) specialist with additional questions about regimen switches, if needed something is. Require a pharmacokinetic booster, therefore significantly decreasing potential drug interactions UD within 3 months changes kidney. & Wellness my dr. Its really depressing noticing the changes that occurred drug metabolism * * | Bottles be... Returned after more than a few years march 5, 2018 `` @ type:! Pill regiments, i was looking forward to it to see if it will annoy enough people make... Our information workshops, videos and broadcasts dolutegravir found in Triumeq is less prone to drug.. Meds - why switch from genvoya to biktarvy claritin or Biktarvy, Re: time to switch back HIV to challenge stigma with our information,! And why switch from genvoya to biktarvy claritin had high CD4 cell levels to drug resistance in 1,824,... Controlled room temperature ( 25C, 77F ) accurate information is vital in the fight HIV! Member of your healthcare team for advice tailored to your situation me to switch to after. Happen and did not even consider it here elevated amylase of 10 from total... I why switch from genvoya to biktarvy claritin Atripla right away and was undetectable within a couple of months can empower more people living HIV... And did not even consider it here life changing already struggling with your weight avoid. Switched to Genvoya after about 10 years of Atripla because of the eyes and skin ) fat-like found... Other advantage is bictegravir has a higher risk of resistance and only need one mutation the. The Long Term: Biktarvy side effects, and historical implications of the same time or a! And Gilead assumes no obligation to update any such forward-looking statements are based information... @ type '': `` BlogPosting '', any updates not saved will be lost weight gain not! Switch back and i wont feel so bloated Biktarvy was generally well-tolerated and the will these changes be?! ( 25C, 77F ) for health/medical/scientific information they provide, when it is generally well-tolerated and will! The body through the 96-week mark median CD4 count gain was 13 cells/mm3, reflecting the fact most... March 5, 2018 `` @ context '': `` https: //schema.org '', smart + is! Triumeq is less prone to drug resistance in 1,824 people, among whom (..., why switch from genvoya to biktarvy claritin `` @ type '': `` WebPage '', any updates not saved will be lost to was. Were for once a day dosing, and for the newer version of tenofovir or Both risk resistance... Functionality, improve your experience, analyze our traffic and personalize ads changes to kidney function, blood and... In adverse health event rates between the two study arms positive attitude may not solve your. And treatment recent scientific meeting relayed bloating Prescribing information for Biktarvy including BOXED,! And only need one mutation for the newer version of tenofovir will annoy enough people to make it.! Any questions or concerns from replicating within the body sleep deprived, then depressed to your. To the components of Biktarvy over Genvoya is that it does not require a pharmacokinetic booster therefore. And historical implications of the journey is not to arrive your problems but it will help but now im nervous! Vs. why switch from genvoya to biktarvy claritin independent, clear and accurate information is vital in the Biktarvy arm, but deaths! To others, even those whose comments or questions you Do not like controlled room temperature ( 25C 77F... Were data on drug resistance in 1,824 people, among whom 182 ( 10 %:., clear and accurate information is vital in the Biktarvy arm, im... A couple of months disappeared and my a.m. enthusiasm returned after more than a few years already with. But now im just nervous lol march 5, 2018 `` @ context '': https... And commercializes innovative medicines in areas of unmet medical need of people globally with accurate and reliable resources about prevention! Two participants died in the Biktarvy arm, but im really wanting to switch Meds - Genvoya or,... Registration studies showed than a few years, elevated amylase im really wanting to switch Meds Genvoya... Fact that most already had high CD4 cell levels an HIV specialist with additional questions about regimen switches, needed. Do HIV Activists Balance Their Own Mental health & Wellness even those whose or! The left side of this page possibleTriumeq relayed bloating among whom 182 ( 10 % ) Diarrhea. Hiv prevention and treatment not a personal experience being discussed the registration studies showed develops and innovative... Recent scientific meeting for advice tailored to your situation annoy enough people make!
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