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Brother is sick from medications, please help

May 20, 2007

Dear Doctor, My brother just started on Combivir and Efavirenz 4 days ago. CD4 110, VL 115k

Eversince he started on medicine he has been complaining of nausea, cramping, body pains and extreme weakness in general.

Here are my questions: a) Should we be worried or are these side effects normal? b) Will these side effects go away with time? c) His food intake for the last 3 days has been ~60% of his regular intake. Should we be worried? Should we force him to eat more? Will eating less cause more side effects? d) What else can we do to make sure he does not give up on the medicine?

Any suggestions are eagerly awaited. The whole family is extremely anxious and worried.

Appreciate your wonderful work. God bless. K

Response from Dr. Pierone

One of the reasons that AZT (which is contained in Combivir) is not used as much anymore is because of its poor side effect profile. This agent is more likely than some of the other available medications to produce nausea, vomiting, and malaise.

Chances are that he will need to change his regimen, and it would be best if this were done sooner rather than later based on your post. Some people will have some improvement over time, but in general the side effects from AZT do not completely resolve until this medication is switched to a better one.

Recent studies have shown that Truvada is superior to Combivir, so this would be a logical switch.

Thanks for posting and best of luck to your brother.

JAMA article on virus inhibitory peptide

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