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methadone & HIV & liver
Sep 9, 2004

I am 52 yrs old diagnosed 1994. I have been on methadone for 20 yrs. Cocktail working good. Now have liver problems. I went up on Methadone 70 ml because cocktail ate up Meth. Should I stop cocktail to be able to come down on Meth. Will that help the kidneys? I have been to hospital twice in 2 months. Extract liquid from stomach then it blows up when I get home. What can I do?

Response from Dr. Conway

It sounds as if you are developing ascites, or water in your peritoneal cavity as a result of severe liver disease. In this case, it is not rare to see someone develop kidney failure as a result of your liver disease.

In people with severe liver disease, we often see a decrease in the methadone dose, as the liver does not clear the methadone as efficiently. Some drugs (especially nevirapine and efavirenz) make your liver clear the methadone more quickly, and you will need a higher dose. This seems to be the case with you.

The methadone itself is not harming your liver. I would be more concerned that, if possible, you be on antiretroviral medications that do not have any liver toxicity. This may mean changing your cocktail, and this may lead to you decreasing your methadone dose, especially if you are on nevirapine and/or efavirenz.

Both Poz; neither on meds yet; Genotypes similiar
cutting edge therapies for wasting?

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