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Changing therapy
Jul 29, 2005

I am working in an HIV/AIDS project in very remote and rural part of Ethiopia.we are using the generic drugs and our first line therapy is D4T(Stavudine),3TC(Lamuvidine)and Nevarapine.some patients develope Tuberculosis mainly Pulmonary asfter start of treatment as part of IRIS and wehave to switch therapy to Efavirenz and there was suggestion to continue the Lamuvidine and Stavudine alone for one week and then start him on Efavirenz as there is an assumption that Nevarapine will stay in the blood maintaining its therapeutic levelbut I coundn't find any evidence in the book so could you clarify this thing to me Many thanks


Response from Dr. Young

Abren- Thank you for your post.

There shouldn't be any need to continue d4T + 3TC without nevirapine if one switches directly over to efavirenz. The reason that you've read about such a discontinuous stop is when the goal is to stop all treatment- then the differences in the half-lives of d4T,3TC and the NNRTIs can engender risk of developing drug resistance.

In your patient's situation, I'd simply switch efavirenz for nevirapine and continue all medications without a lapse in three drug treatment.

I hope this helps, BY

PEP at double dose Please help!

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