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Medication change
Apr 18, 2001

Dr. Boyle. I wrote you several weeks ago regarding pressure headaches. I have been on combivir and viracept for a year and 4 mos. My CD4 is 600 and an undetectable viral load. A CT scan of my brain and sinuses has proved negative. I have been discussing with my doctor about switching my meds, possibly Sustiva because of the lessened effect of liver toxicity. Do you think this is a good idea or should we pursue other avenues to determine the reasons for the pressure headaches? Once again, thank you for your assistance.

Response from Dr. Boyle

I have switched many of my patients who have a good CD4+ cell count and an undetectable viral load (<50 copies/mL) from Viracept (nelfinavir) to Sustiva (efavirenz), due to issues of side effects, tolerance, avoidance of metabolic complications and convenience. Many studies have shown this to be effective and safe, so I think a switch is fine if that's what you want to do. I don't think, however, that the Viracept is responsible for your pressure headaches and further evaluation of that problem seems appropriate. BB

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