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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Are there specialists in allergic reactions to meds?
Jan 4, 2005

I was diagnosed a year ago and became infected within 16 months prior to that. Based on several sets of tests, my doctor advised I begin treatment right away. My latest results are CD4 225 and viral load 50,000. I got a bad rash and was hospitalized from the first combination, Combivir and Nevirapine. We had to stop the second combination, Combivir and Nelfinivir, also due to rash (which was different from the rash caused by the first combination). Earlier I had an allergic reaction to Septra. I am very worried that I won't be able to tolerate any combination of HIV meds, and will therefore be untreatable. I saw an allergy doctor locally, but that doesn't seem to have been of much help. I think my doctor will be advising that we simply try again with another combination.

My question is: are there HIV specialists anywhere (Canada, U.S., or elsewhere) who have specialized knowledge of allergic reactions to HIV meds (if "allergic reaction" is the right way to describe my experiences)? I'd like to know whether I could be tested ahead of time to see what combinations I could tolerate, or whether there are special ways of managing reactions so I don't have to discontinue again.

Response from Dr. Henry

Reactions to nevirapine and sulfa are fairly common so that is not unsual. The nelfinivir reaction is more atypical. Some patients I have seen seem "snake-bit" when it comes to tolerating meds. There may be an genetic component but that type of analysis is not ready for regular clinical use. Trial and error approaches are often the only practical option. I haven't had much success with dermatologist or immunologist/allergist in helping me identify quickly a regimen that would be well-tolerated by a specific patient. In the US, at least, there are many treatment options, so it remains unusual to not find a well tolerated regimen for a given patient, but the process can be frustrating. KH

recurring unilateral swelling of right side
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