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Changing treatment regime
Dec 17, 2005

Dear Doctor I started tritherapy end of July 2005 I took trizivir for 3 months and suffered continual abdominal pains, sleeplessness and chronic fatique. My viral load went undetectable. I changed to Viramune,Epivir and Viread 4 weeks ago - I have now developed Hep. A with jaundice etc and stopped the Viramune on the instuctions of my doctor. I am told I have to wait 10 days before I replace the viramune. I was oof work in 1982 for 8 weeks with Hep A and am positive to Hep B and C and was surprised when I read the serious warnings about liver damage with viramune. After doubling the dose the Hep A set in . What alternatives do I have left ? I am 56 and was positive for 20 years before needing treatment. I understand that at my age the combination of HIV and Hep C is particularly difficult to treat. I have tried to work (am self employed ) but find I can manage only the simplest of tasks due to the lack of concentration following on from the fatique and stomach discomfort. Is there any test they can do to see which treatment would fit my body profile ? Should I change my doctor who otherwise has a good reputation?

Response from Dr. Henry

Stopping drugs like Viramune can be tricky due to the risk for development of resistance. Usually patients can tolerate a protease inhibitor-based regimen or possibly an efavirenz based regimen in cases after liver problems like you desribe (checking a resistance test can help sort that out). It is recommended that,if possible, persons receive their HIV care from a doctor with HIV experience (an HIV specialist). Liver problems can frustrate good doctors and involved patients . Again, in most cases patients with hepatitis B and C can be successfully treated for their HIV but sometimes it seems like a trial and error process until the right mix of drugs is found. KH



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