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Is it advisable to change the treatment
Jun 21, 2006

Hi, I told you last december that I was taking Nevirapine and Lamivudine+Zidovudine. My doctor suspended Nevirapine at the end of December because I had a lot of rash on my skin. Then the second week of January I started with Efavirenz 600mg instead of Nevirapine. My Viral load in April dropped from 93,000 to 141 and my cd4 count from 212 to 420 in 3 monthes. My problem is I can not sleep without vivid dreams or nightmares. I am thinking to tell my doctor to change the therapy. Is this a good idea? Is there a better therapy than Efavirenz? By the way my girlfriend still tests negative. Thanks

Response from Dr. Young

Thanks for your post.

Unfortunately, it sounds like you're having another round of unacceptable side effects. Typically the sleep disturbances from efavirenz wane by this time, so if you're still having difficulty, it would certainly be worth discussing your symptoms with your doctor.

Some patients can manage this with the addition of a medication for sleep, like Ambien or Lunesta. If this doesn't help, then it's probably time to explore other options.

In your situation, the next alternative would be a protease inhibitor- I typicall would use a boosted PI in your case. Talk to your doctor about which medication option is best for you.

I'm confident that with time and patience, you'll find a regimen that works well for you.

Best of health. BY

Kaletra or Sustiva
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