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Truvada & Stockrin side effects after 8 weeks
Mar 30, 2008

I am a 37 year old male - 5 years HIV+ and Hep B, 8 weeks on truvada/stockrin -CD 4 up to 205 from 111 and viral load 7000 from 300 000,liver function tests still high and under strain from chronic Heb B infection, but doing much better, so all is going well in that regard. I have had no o.i's apart from the flu (which had the entire country on its knees) and never skip a days work, no matter how bad I feel from the meds or my discomforts. A few things worry me terribly as it does not seem to improve:

1) The delibitating vertigo (utter hell!) I suffered, lasted 2 weeks and is ok now during the day, but severe at night - and I wake up several times during the night (with a fright). I battle to sleep again and then lie awake frusrated in a drunken stupor. I have hot flushes and viciously accellerated pulse upon waking at night. It is like a combined shock and panic feeling and then unreasonable aggression sets in. Immediately upon waking up, I have imaginary arguments with the neighbours and their barking dogs and cars that woke me up, then I fight with the people at work who angered me and then a host of petty and more serious worries spirals until I am so worked up I scream out loud and hit my fists against the walls. Literally. It seems to be the only thing that helps and once this lashing-out subsides I can dose off again, as no amount of breathing or meditation or concscious relaxation seems to work! Before meds I was a placid, calm and pleasant guy. These tantrums are disturbing, ridiculous, extreme and not in my nature and scaring me a little, as it can be set off during the day too and I get into heated and emotional fits with people! Will sleeping pills, anti-depressants or tranquilisers help me shut out the noises of the world and temper my aggression, without interfering with my meds, other symptoms or my liver function? Am I turning psycopathic or becoming a paranoid schizo? Is this AIDS dementia? I avoid my friends and evening social gatherings (for fear of losing my temper or turning spastically drunk on my medication). I can't seem to get a grip on myself. I need serious help here. 2) My eyes burn constantly, are terribly light-sensitive in the afternoons and my eyelids feel "heavy" all the time. I have a gaunt, haunted, tired, zomby look all of a sudden, and feel the part too- the right side of my face often sags with a droopy eyelid. Decidedly odd...I am unable to take naps no matter how little I sleep the night before. I just lie with closed eyes fighting with the world again, with fractured thoughts, looking more wasted and aged, and feeling more tired and joyless as my days go by. 3) I battle to read and study (doing a Masters Degree in Education) so it is causing serious worry now as I get nothing done and can't focus or seem to remember what I studied and are most of the time simply unmotivated, listless, depressed and tired! I was awarded a bursary last year (when I was still happily ARV -free) and it will have severe financial implications if I fail my year. My academic work is now way behind, not to mention that my job focus is all at sea. A friend suggested taking ephedrine, crystal meth or cocaine from time to time to sharpen up my mind and override the constant fatigue and get some work done. I am not so sure about this though, being a teacher and all I can lose my job - it is a bit extreme and illegal here, but I am desperate and willing to give anything a shot if it would only help. 4) I urinate at least once or twice in the middle of the night, which also wakes me up, apart from the bizar dreams, barking dogs, hooting cars and imaginary arguments and chatter in my head. It does not matter whether I drink or dont drink something before bedtime - my bladder fills up like a hot air balloon and anytime between 2-4 a.m. I wake up. After bashing into a few walls from the vertigo, I find the loo and have to sit and pee as I am unable to stand upright or aim properly and then I am awake in my bed again, arguing away in my head! It is funny in a black humour sort of way, but I burst into tears the other night from sheer frustration, anguish and fatigue, never knowing when the last nocturnal pee is going to be the bloody last pee. I drink 2 liters of water a day as is suggested by all and sundry. 5)I am either hyperactive, histerionic, lethargic, aggressive or absolutely melancholic: all in a day which drives me and everybody who knows me and used to know me being a happy goes lucky person, nuts - I am emotionally flippant and unpredictable 5) I teach secondary school mathematics and find the noise the kids make lately (and all noise quite frankly) unbearable and heightened so I scream at my kids, just to feel terrible about it afterwards - so not like me and not on! 6) I smoked about 5 - 10 cigarettes a day and was in the process of quitting - well, on the meds I am up to 20+ a day and cannot seem to control it at all - its like I am "craving" all the time and it alleviates the jitters I experience. If I dont smoke, I eat, or talk, or drink, or pace back and forth. Is this compulsive behaviour normal on meds? I get tired just observing myself! 7) I eat like a starved horse all of a sudden and my six pack is now covered in an odd-looking, uneven belly - I have only picked up 4 kgs (weigh 56kg 170cm tall) which has always been my normal weight and I continue to exercise regularly - is this lipodystrophy already setting in so soon? How does one detect the onset of lipo as opposed to gaining weight normally from eating as I find no answers in any forums here or a clear cut test for it anywhere on the internet? I am horrified at this growing tube over my bladder area (I remain skinny elsewehere!) and cannot exercise more than I do (or eat less as I eat healthy, low-fat food). I have NEVER had a belly or been overweight in all 37 years of my life and would do anything to avoid becoming humpty dumpty at age 38. Has my metabolism changed? My question is, should I be concerned for reasons other than vanity? 8) Some mornings I wake up and the first thing I have to do is vomit uncontrollably, with terrible intestinal cramps (but not really diarhoea) and then I feel "hung-over" and shaky all day. My throat burns and it tastes bitter. I cannot keep in as much as a glass of water, it all comes wrenching out. Can this still be my liver acting up (I have no problem eating anything, the colour of my stool is normal) or is it the pills you think? 9) I suffer from peripheral neuropathy (I assume) in my arms, legs and feet, but pain is just pain and I dont mind this really - can I carry on exercising (I swim, do weight training and I am a yoga instructor) with these pains since I simply ignore them and "bite the bullet".

Are most of these symptoms side effects from my stockrin/truvada combo after 2 months? I take purbac and no other medication with it. I do not drink alcohol or use drugs, recreational or prescribed, take vitamin supplements and Milk Thistle for my liver and live as healthy as I possibly can (apart from the damn smoking thing that escalated out of control).

I am gradually becoming severely depressed - I can accept that my life changed with the meds, but to this extreme? I feel dumber, permanently tired, snappish, irratable, unreliable, lazy, anxious, nervous, panicky, I procrastinate important decisions and tasks, I seem pathetic to myself at times, self-pitying and sometimes wonder if I am just hypochondriacal.I constantly suffer from some or other minor but uncomfortable effect and don't even mention any of it when asked if I am well. I am never "well" anymore. I dislike the person I have become on the meds and very sad about it. If I know the effects will subside in the next few months I will bravely bear them, but I am feeling a tad hopeless at this point in time. I am a shadow of who I used to be...

All I ache for is uninterrupted sleep for a night, to have my mind back again, work a normal day with sustained energy and get my emotions under control. I guess I can live with a belly if that must be and even resolve to have sex with fellow muppets. It is just so terrible and disturbing to see my once-toned body doing its own weird thing.

I apologise for this detailed rambling of my problems, but my doctor is rather unsympathetic and stated that I should be glad that I am still alive and getting better and are able to do what I do. He is of the opinion that this is how life with AIDS on meds is, can be or worse. Is this the reality of it and should I accept these symptoms? He sees no reason to prescribe anything to alliviate my side effects and says I should give it time. Given what I have (aids - hep B, compromised liver and spleen function), there are limited options in terms of treatment. Is this true? Though I think it unwise to change my regimin this early in the game, as it does work, I tend to disagree with my doctor and aspire to live a reasonably "normal" life again with the ambition of studying and working successfully, have pleasant relationships and live a quality life like others, by the grace of God. Or am I just fooling myself that there is things I can do to improve my conditions? I feel like dumping all my pills in the same toilet that has become my dreaded nocturnal pitstop.

Your advice is greatly appreciated.

Response from Dr. Henry

You may be having persistent problems related to the Stocrine (efavirenz). I would discuss with your HIV specialist a possible switch to an alternative drug such as nevirapine or a boosted PI (what ever is available to you) on a trial basis (should be able to tell within a month whether many of those side effects improve off Stocrine). KH



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