Dear Docs! For the last 2 years I have been responding to a Kaletra+Combivir combo quite succesfully : CD4 around 500 +-100, and VL underneath the recognition line; no major gastric or other kind of side effects,but only experiencing sleeping disorders since the beginning of the med. therapy: unable mostly to sleep through! when needed lorazepam will make me sleep through ( though I do try to avoid it )After consulting with my Doc, he suggested to switch the Kaletra to Viramune ... a good suggestion? could it help break that sleeping disorder pattern? thank you very much for your advice Steven

A small percentage of patients have a sleep disturbance possibly linked to nevirapine. If you have no resistance then switching to another medication like nevirapine is a very reasonable option (Sustiva if often considered as well but sleep problems are even more common with it). The major issue with viramune is liver and hypersensivity reactions during first months on therapy. That may be more common if the CD4 count is high so patients need to be watched carefully during first months after nevirapine started. KH