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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Sustiva, Truvada & Viramune
Oct 15, 2005

When I was 19 I was diagnosed with narcolepsy and DID. I tested positive almost 3 years ago at the age of 43 and 2 years ago started my first meds -- Combivir and Sustiva. For the next six months sleep was nearly impossible. The vivid dreams didn't go away, they got worse. A few hours after taking Sustiva I would fall into a stupor for hours. During the 6th month, my partner was so concerned that he drove me to another county and I was told to discontinue meds immediately. For more than a year I went on a drug holiday until my CD4 cells dropped below 200. That period was pure bliss. Then another physician started me on Truvada and Viramune. The result was that I felt constantly like I did when I had Hepatitis A. My skin started turning yellow and I often felt slightly feverish. After the first month, I started developing a pain on my left side. After falling down on a sidewalk, I ended up in an ER where I was told to discontinue meds as it was suspected that my body was reacting to Truvada, however, I was told that Viramune also had a notorious reputation for causing inflamation of the liver. My doctor has taken me off Travada and recommended Epzicon and Viramune. I have not started this regimen since I've heard about hypersensitivity issues w/ Epzicon. I don't feel comfortable with this as I have heightened iatrophobia. Can you pls let me know if my concerns are valid? What would you recommend?

Response from Dr. Henry

I assume you are seeing someone who is well experienced with HIV care (that is important). I often would use a boosted protease inhibitor based regimen even from the beginning in a case like yours (such as Kaletra or ritonavir-atazanavir). In some cases if I didn't want ot use a nuke at all I use double boosted PIs (such as Kaletra + Invirase or atazanavir) alone. Much depends on resistance history, liver status, etc. Abacavir (part of Epzicom) often a good drug with little overlap when patients have experienced problems with the NNRTIs (first 8 weeks are tha key with abacavir watching for the hypersensitivity reaction). KH

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