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cant find the right 3rd. component

Dec 1, 2012

hello Dr. Young, you are always so kind with your counselling here. I have been on ARVs for 11 months now. Viral Load went from 50,000 to undetectable, CD4 counts have slowly improved from 140 to 190, my % went from 4 to 5. My ARVS have been always Truvada (Tenofovir + Emtricitabine), with only minor side effects (accumulated weight in belly , but we can talk about that later on). So for the time being Truvada is ok. My problems starts with the third component. I had Efavirenz but developed deep suicidal depression, so had to cancel it. Now my 3rd. component is Reyataz + Norvir. An this is my situation now: both of these components affect my CNS a lot. Reyataz makes me quite dizzy. But the real problem is the Norvir, for i am almost knocked out, and makes me feel i am a zombie, with no desires for anything, and then i get suicidal feelings, for who wants to be a vegetative nonentity. What is your opinion on this? So now i am only taking Truvada + Reyataz, skipping Norvir (which i know is prohibited for it boosts my Reyataz). I am almost sure that my CD4s have improved so little because i am skipping the Norvir, and the Truvada + Reyataz cant overcome the HIV inside me so succesfully without the Norvir. My doctor said that i have to take all 3 meds because i am running out of options. I find myself in a tight spot trying to figure out the how to find a solution. My age is 59 years old. Your opinion will be most welcome. Thank you. p.s. I wish I belonged to the "Exclusive HIV no-side effects ARVS Club", but they dont accept me as

Response from Dr. Young

Hi and thanks for posting.

First off, please don't take just the Truvada and Reyataz- you'll risk developing drug resistance and jeopardizing many good future treatment options.

Don't give up yet on the No Side Effects Club just yet.

It certainly sounds like you've had more than your share of unwanted side effects. The complications of efavirenz (Sustiva, Stocrin, and part of Atripla) are characteristic and seems reasonable to avoid this medication. The symptoms of dizziness and mood that you experience from Norvir/Reyataz are unusual, as this usually causes GI side effects (like nausea and diarrhea).

There are a number of alternative 3rd agents that you could consider. First is the twice-daily, but very well tolerated integrase inhibitor, Isentress. We've had an excellent experience in patients who take this with either Truvada or Epzicom. Next, the newer one tablet combos of Complera and Stribild offer ease of dosing (once daily) and minimum side effect risks.

Lastly, since both regimens you've been on included the parts of Truvada (tenofovir and FTC), consider discussing with your doctor the possibility that these might be contributing to your side effects.

No matter what, know that while not usual, nearly everyone can eventually find a very well tolerated regimen. Sometimes it can be frustrating to go through this process, and I've seen a few patients and friends go through this, but in the end, they've found admission into that No Side Effects club.

We well, BY

Antiretroviral drugs research
Late a dose of PEP on 26th day

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