Aug 8, 2004
my brother's cd4 count 128 viral load 28 000. started on combivir and nevaripine. developed rash grade 3-4 and fevers and vomiting 5 weeks later. nevaripine stopped and his doctor suggested continue with combivir and restart low dose nevaripine after a week.I am not happy with that I would like him to start efavirenz rather than the nevarapine immediately. what is your advice.
Response from Dr. Young
Thank you for your questions.
From what you've described your brother developed a pretty severe allergic reaction to nevirapine. As such, I would not recommend that he resume treatment with nevirapine. Moreover, I would definitely not recommend Combivir alone treatment prior to the resumption of a third drug (nevirapine, as suggested by the doctor), since this would needlessly place your brother at risk for developing drug resistance.
Your suggestion about the use of efavirenz (Sustiva) in place of nevirapine makes sense to me, and would start both (three drugs) at the same time, rather than the step-wise fashion that was suggested.
Hope this helps. BY
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