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Sustiva timing

Jan 17, 2007

Dr Young greetings from the UK and thank you for your clear and helpful answer to my question Practical implications of an AIDS diagnosis in November 06. Im taking Kivexa (Epzicom) and Efavirenz (Sustiva) and I have been pleased with my results: CD4 401 (21%) to 566 (25%) to 671 (31%) and VL 120,000 to 121 to <40 at baseline, 7 weeks and 12 weeks after starting treatment. My two KS lesions are fading nicely after only 4 months on treatment.

Initially I had very few side effects until I was switched from twice daily dosage to once daily dosage and the Lamivudine was changed to Emtracitabine for its greater time tolerance. Unfortunately a couple of weeks later I started feeling spacey, struggled to find words and felt fatigued. My HIV consultant switched me back to Lamivudine (great for me as this was in the form of one Kivexa tablet) and the symptoms resolved a couple of weeks later. Im now feeling very well, exercising and am really happy with my treatment and so far have had no missed doses.

Now, Im aware that the Kivexa is fairly unforgiving regarding timing and I keep to a fairly strict 30 minute window for taking it. However Ive been told that the Efavirenz is quite forgiving and that I can take it just before going to bed, which often means that its within a two hour time window.

My question is: just how forgiving is Efavirenz and am I OK taking it at any time from 10 pm to midnight?

Very best wishes, Steve

Response from Dr. Young

Hello Steve, it's good to hear back from you in the UK.

You've had a frankly unusual side effect of the FTC (emtricitabine, Emtriva), but I'm happy to hear that you're better now.

The regimen of abacavir/3TC (Kivexa, Epzicom) with efavirenz (Stocrin, Sustiva) should be a very well tolerated and durable one. I'm not sure where you're getting the information about the "unforgiving" nature of 3TC, since the medication is routinely (for years) given once daily- with a very robust clinical trials history. As with any once-daily medication, there is a pretty large time window that you can take your medication without signficant risk to the regimen.

I'd think that the two hour time window that you've mentioned would be well within any safety margin for both Kivexa and efavirenz.

Best of health to you, BY.

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