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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Can I survive this rash?
Sep 9, 2004

I was diagnosed in January. I'm 52. At that time my CD4 was 365; viral load 190,000. By June 23, my CD4 was 302; viral load something over 750,000. So I started Sustiva, Epivir, and Viread, all at bedtime, on July 22. Around August 10, the rash started, just on my inner arms below the elbow. Each day it gets a little worse. Now (Sept. 5) my neck, front, all of my arms to my knuckles, most of my back, groin, and thighs are bright red; there's very little plain skin left. My armpits weep, my groin weeps, and today my elbow joints began to weep. It all hurts; it all itches. My clothing sticks to me. Benadryl, topical and oral, doesn't help. In fact, oral Benadryl just makes me flake all over. I put lotion on all over about six times a day, maybe more: Cetaphil, Kiss My Face, Alba Botanica, Elidel, 2% diphenhydramine, 1% hydrocortisone. I get a short respite from the itching but the red marches on.

The good news is that on August 20, my CD4 was 447 and my viral load was 1,300. I'm 1000% adherent. I really want to best this. But I'm getting a bit worried. My doc won't be available till late next week. I'll stop fretting if someone can suggest that I'll get over this.

Whatever your response, I want to thank all of you at The Body for just being available. You've helped me more than you can know. I appreciate you.


Response from Dr. Henry

Rarely has a Sustiva rash been life threatening-yours sounds quite severe. I recommend that you see a doc with HIV experience (? partner of your doc) to make sure your liver and other key organs are OK so that a decision can be made about whether you can continue the Sustiva (next choice would be a protease inhibitor such as Kaletra). This is a big deal since stopping without starting something else puts you at some risk for developing resistance while continuing Sustiva if the rash worsens worries me as well. I often have tried to tough out even bad Sustiva rashes but that assumes someone is seeing the px and monitoring the situation directly. KH

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