|Risks of swapping Efavirenz for Viramune?
Sep 22, 2005
Hello, firstly a big thank-you for your site and the wealth of knowledge on here.
I have a question regarding the potential severe side-effects of Viramune.
I have been on medication for approximately 1 year, a combination of Efavirenz, 3TC and Tenofovir. The results have been good; Cd4 rose from 240 to about 340 with an undetectable viral load after 7 weeks.
By nature I've always been optimistic and enjoyed life enormously and I feel that the Efavirenz has taken the edge of things.
While the initial severe dreaming and night discomfort from the Efavirenz obviously went away, I am still left not really having a very relaxed sleep, dreaming much more than I would like and also often feeling a little bit "down" or "flat".
I tolerate the 3TC and Tenofovir very well and was thinking of swapping the Efavirenz for Viramune. I have read though that the potential for severe skin reactions with the Viramune is quite high.
As a child, I had a very serious Stephen Johnson syndrome caused by Sulphonamides.
Here are my key questions:
Having had a Stephen Johnson syndrome once, am I more susceptible to having one again?
How safe is Viramune?
Is there any way to test the potential reaction before starting on the drug?
Any thoughts would be very welcome.
| Response from Dr. Henry
Good question. Substitutions usually go OK but in your case I would be doubly cautious given your history. I generally would consider a switch to either an atazanavir based regimen +/- ritonavir (often switching the tenofovir to abacavir before hand) or even consider Trizivir + Viread if no history of NRTI resistance. KH
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