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Viramune or Sustiva

Dec 4, 2000

I have been on medication for 2 years this month. Combivir and Viramune. My Doctor wants to change me from Viramune to Sustiva I am very unhappy about this and worried. I had no side affects from the Viramune and my viral load has been undetectable for the last 22 months. I really want to continue on the viramune without dealing with the side affects of Sustiva. Is there any advantage in the changing of my med?

Response from Dr. Pavia

This is a situation where I worry that I might only know half of the story. From what you are telling me, I am not sure why changing would make sense. In general, I like both Viramune and Sustiva; each has its own advantages and disadvantages. Originally, we had better studies for Viramune, and there were questions about whether it was as effective as Sustiva, but I think those are largely matters of history. There are some very limited reasons I might consider switching someone with a controlled viral load. One is if you were having a lot of liver problems, it might be worth a try to switch, although both drugs can cause abnormal liver function tests. The other is if you were having problems remembering to take all of your doses. Both drugs can be taken once a day, but because Sustiva has a longer half life, it might offer some protection if you miss a dose. Otherwise, I would find it difficult to find a reason to change in someone who is doing well for two years and has no side effects. However, get the whole story. I may be missing something here.


Andrew T. Pavia, M.D.

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