|New to PI and having problems, can I switch?
Apr 12, 2001
I tested positive recently (consistently negative until 8 mos ago/last test). My VL was 15,000 and T4 was 393. My doc started me on 3TC,d4T and efavirenz. I developed a rash 11 days after, and my doc switched my Sustiva to Fortovase immediately. I knew the incidence of rash with Sustiva, and that it "may go away" in some people. My doc didn't want to take any chances. (I was bummed because I didn't have any more neurological problems with Sustiva by then, and it was a much easier dosing to adhere to. Fortovase gives me a warm feeling in my stomach and some abdominal discomfort every time I take it.) Two weeks after the switch to Fortovase, my VL was down to 427 and my T4's went up to 518. However, my SGPT went up to 100 IU/L and my blood glucose up to 159 mg/dl. I have 3 questions, and I'd appreciate your comments: 1) Should I have insisted on staying with Sustiva despite the rash? Incidentally, it took a week for the rash to go away after I stopped taking Sustiva. 2) Should I consider another NNRTI instead of a PI, because of its apparent nasty effects on my liver and blood glucose level? Some of my friends have told me that I shouldn't have started on something as potent as a PI immediately, as my VL was on the low side to begin with. 3)Should I worry about the high SGPT and blood glucose at all? I'm afraid of the liver toxicity and risk for type II diabetes. Thank you so much for your time. You have a great website and are very helpful to us all.
Response from Dr. Henry
I often would treat through the Sustiva rash. You might want to consider staying with the current regimen for several months to see how everything settles down for you. It might be worthwhile to know your hepatitis B/C status to best interpret your liver enzyme elevations. If you are doing well after several months you could stick with your current regimen or consider trying a switch back to Sustiva or maybe abacavir (Ziagen) as protease sparing regimen. You should also have you fasting blood sugar rechecked shortly. KH
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