|Urgent. I need advice on meds change. Thank you!
Jan 9, 2013
Hi! I'm a 31 yo Brazilian young man and I've been taking meds for exact 6 years. I've been on biovir and efavirenz. These are my first set of meds. About a month 1/2 I've been having problems with adherence. I never got any side effects from biovir (maybe some lipodystrophy, which is annoying) but lately I've been getting headaches from it, my heart goes fast, and I get a buzz and some mental confusion and it got impossible to go on taking my meds. I couldnt even get my work done cause of these side efects. My doctor insisted that I kept taking them, cause my counts are goog (load - undetectable and cd4= 610) and after a week without them I tried again, but I had those bad side effects, then I stopped taking them for another few days, gave them another shot, but again it got impossible to work or to do anything since I feel like my mind gets affected and I can't focus or think straight. I know efavirenz usually does that, but I didn't know biovir would. At night, having them both together makes it even worse. So I haven't been taking them and my doctor called me asking me to go see her tomorrow cause she wants to suggest new meds. As I really want meds that will adjust to my lifestyle I would really appreciate getting a suggestion from you, doc Benjamin, a second opinion. This is kind of really urgent, cause I haven't taken my pills for over a month and I feel like I need to get back to treatment as quickly as possible. My doctor doesn't pay attention to when I say that I want to avoid lipoatrophy. I'm really considering a doctor change. Wich meds would you recommend? I'll be very thankful if I get some suggestion from you! I'm gay, love doing sports, want to avoid lipodystrophy and avoid mental damage. Thanks a lot in advance!
| Response from Dr. Young
Hello and thanks for posting from Brazil.
Seems like you've developed intolerance of your efavirenz. The side effects that you've reported are quite characteristic, and I think that you've demonstrated a very good cause and effect relationship between your medications and symptoms.
Ask your doctor what options are available as an efavirenz substitute- depending on availability we would consider using the other NNRTIs (nevirapine or rilpivirine), a protease inhibitor (atazanavir, darunavir, or in other countries, Kaletra), or the integrase inihibitor raltegravir.
I hope that helps and please feel free to write back, BY
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