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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.

Peter Eruba

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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