|cns vs renal effects
Apr 26, 2003
Dr. I have decided to intensify treatment with either sustiva or viread.I am currently taking trizivir alone with great results,Undetectable and 550 t-cells. I am curious what you would consider the better choice.I am concerned about the cns effects of sustiva.What percentage get this effect and does it stay with the majority of people or resolve.With viread my concern is with acute renal failure. Also I take valtrex for herpes outbreaks and have read that there may be a moderate drug reaction (increased levels) between viread and valtrex since they are both excreted by the kidneys. Which would you consider the safer and more effective choice . thankyou
Response from Dr. Henry
Excellent question. There is little good data upon which to base a firm opinion. You have a good understanding of the major side effects concerns for both of the two drugs under consideration. A significant fraction > 30-40% of persons who take Sustiva will have some degree of early CNS side effects. They usually taper over 1-2 months so that maybe 10-15% continue to have troublesome side effects. The renal toxicity of tenofovir so far is an unusual event (< 1-2%) over the first 1-2 years of use. It is unknown whether careful monitoring of renal function could pick up early problems before clinically significant. The issue of which drug to use also involves one's philosophy of care. I usually try to save classes of drugs for later use so try to get by with just the NRTIs if patients are doing well (so I would vote for the tenofovir for that reason). KH
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