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Restarting Meds after STI

Nov 27, 2009

I am a long term survivor(25 yrs) and finished 48 wks of Interferon/Ribavirin for HepC 12 wks ago. For 6-7 yrs I had been on Sustiva/3TC/d4t with Very minimal side effects. Once the ribavirin kicked in good so did the the facial lipoatrophy. I was also experiencing weight loss in general from the hyper thyroid caused by the interferon. My Dr. switched the d4t to abacavir at around 24 wks. Once I finished the HepC treatment I was worn out! A month later I started a holiday. 8 wks later my CD4 plummeted from 500's/38% to 125/11%. My Dr. has sent blood off for a genotype & resistance. If those test come back positive, would you suggest restarting Sustiva/3TC/Abacavir or another combination?

Response from Dr. McGowan

I hope your HCV treatment was successful.

If the tests reveal no drug resistance than it would be safe to restart the abacavir/3TC/Sustiva. Since you had been on it for 24 weeks, any hypersensitivity reactions you might develop would have been seen. This combination, unlike D4T is less likley to add to your lipoatrophy.

If resistance is found, then a new combo, dictated by the results should be started as soon as possible. Since your HIV was undetectable at the time you stopped meds, it is unlikely that resistance will be found (especially since you have been off meds). Once you retart you should be monitored closely to be sure that your viral load goes back to undetectable.



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