Hi, I'm a newly dx HIV poz, female who was in the hospital for a DVT. I'm on coumadin for it. I have only had a theraputic level in Sept when I was in the hospital and getting lovonax injections and coumadin, and on Sustiva, Truvada. I had such depression and other side effects, my MD took me off it and put me on Viramune, and truvada. Now I can't get my pt/INR levels to go up. I have been 1.0-1.4, but more closer to 1.2. I'm on 6.5mg of coumadin right now and it hasn't changed yet. What should I do? I asked my provider to at least increase the coumadin by 1mg instead of the 0.5, but I'm thinking maybe I should go to a hemotologist/onc for help getting me at a theraputic level.I'm sick of getting finger stuck each week to see no new results. Thanks for your help.

Nevirapine (Viramune) can induce liver enzymes to work faster resulting in lower levels of coumadin so your situation can pose a challenge. Getting a hematologist or pharmacologist/pharmacist involved along with your HIV specialist is often very helpful. For some patients low molecular weight heparing in used in this setting as an alternative to coumadin. KH