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Add psych meds or just switch hiv meds?

Dec 15, 2013

Dear Dr. Mark,

Long story short: If one has a healthy CD4 count and undetectable viral load but has troubling psychological side effects is it ever worth it to add psych meds or should one just switch hiv meds instead?

Long story: My brother was diagnosed with HIV and his initial labs - vl:571,298 and cd4:320 and started Atripla. He is scared of going to the doctor by himself, so I've been accompanying him to the doctor and I am trying to absorb all the info given to him by the doctor. I apologize if I'm missing other important factors, I'm just reporting what I have seen.

His next labs were vl: 8,455 cd4: 502, but just before his 4-week checkup, he suddenly became really depressed and has unpredictable breakdowns. He has never been this way, so that came as a shock to our family. He called the doctor about what he's feeling, but is thinking about also going to a psychiatrist. He can't explain what he's feeling, he just said it's an extremely hopeless, angry feeling that comes and goes.

I know it's ultimately his decision to either switch meds, get thorough these side effects and hope they pass, or add psych meds to the regimen, but if he ultimately does decide to go to a psychiatrist and add psych meds to his regimen, will they at all affect his response to the hiv meds? Should he just switch hiv meds and hope he won't have these same side effects? He seems to be responding well based off his labs, but these side effects are heartbreaking. I can't take it seeing him like this. Do you have any advice?

Thank you

Response from Dr. Holodniy

If these are new mental health issues, and temporally related to starting HIV meds (which can be seen with efavirenz in the Atripla), then I would switch his HIV meds.

life expectency?
Rising cd8 steady cd4

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