Apr 6, 2005
I am on my second regimen of Hiv meds because I was first on Truvada/Sustiva and got a really bad rash so my hiv doctor switched it to Truvada/Reyataz and as a booster Norvir. It has been ten days on this regimen and was doing great up until today. I once again have broken out in a bad rash, went to see my doctor today that's my primary doctor and he put me on 4mg methylpredsolone and another med for the itch. I have an appt tomorrow to see my hiv doctor to discuss the next step. I want to ask him if it would be ok to work thru this rash and not stop the meds because I dont want to stop and start all over for a third time when I will probably just get another rash from another combination of drugs. My primary doctor said I am just very sensitive to the medications and try and work thru it. What would you recommend. The reason I started meds was because my viral load was 281,000 in january and I have not had follow-up bloodwork yet because I have not yet been on a regimen for a steady six weeks yet.
I am very depressed about this and another thing is I have missed six days of work so far this year because of related problems from the rash and I had a strep throat infection last month, now again with this I will probably have to miss another three days of work because I deal with the public face to face on a daily basis and looking the way I do now its hard to face the public, with a bad rash looks like welts all over my face. So not only do I have to deal with these side effects but my job is in jeopardy as well. I am considering leaving the workforce and go on short term disablity while I am still employed and then apply for Social Security Disability benefits because I feel its just a matter of time before I lose this job.
Response from Dr. Henry
The first month on combination HIV drugs can often be a roller-coaster for patients. Sometimes patients get rash flare-ups as a sign of immune reconstitution (ie flares of seborrhea or eosinophilic folliculitis) which is frustrating (a symptom from an improved immune system). Sustiva can cause a rash itself as could the other HIV meds to a less degree so it is an art form and a challenge to sort out. I tend to try and treat through if the rash is mild-modest and there was a good reason to choose a particular regimen (if on abacavir have to be watched very closely). I have had many patients miss some work early but then within 4 weeks or so feel much better so the call about disability can be a tough one. An experienced HIV provider familiar with your situation is the best person to advise you. KH
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