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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Life with Sustiva
Jan 3, 2009

Dear Dr Henry

I live in the UK and was diagnosed now about three months ago and have been on medication for around one and half months of those. I'm currently taking Truvada and Sustiva (Efavirenz) as a first course of action. With the Truvada part I've had no problems really, on the other hand the Efavirenz part has been another matter entirely. The basic symptoms have been extreme lethargy (takes at least up to midday to really feel awake), insomnia on occasion and feeling quite light headed shortly after taking the medication. I usually take Truvada after my evening meal around 7pm and Efavirenz around 11pm before going to bed.

My dreams has most certainly become more vivid, but as a whole I don't find that discomforting at all. In fact in a twist of irony that aspect has actually become sort of enjoyable. However, I do find it extremely hard to concentrate even into the next day which makes working very difficult especially as I work in a field requiring advanced physics. I've been told the symptoms over time will ease, but I'm trying to understand over what period of time? I've also noticed recently I get occasional muscle twitches shortly after taking the medication and wondering of this is also just a side effect or is it something I should be more concerned with? In addition I have also found my moods swinging quite a bit which is most unlike me.

Just before I started my medication my CD4 count was just over 300 with a VL of around 50K. I did have a serious chest infection just before diagnosis, the VL did however reduce down to about 20K shortly thereafter. My most recent test post treatment commencement has been a CD4 count of 343 with a VL of 143. So clearly the medication is working which is good news. I guess I'm trying to understand if the Sustiva side effects will ever a. potentially be gone or b. manageable to the point where it won't be so intrusive?

Thank you in advance for taking to the time reply to my query.

Response from Dr. Henry

Most likely those symptoms relate to the efavirenz. For most patients the most annoying symptoms generally fade by 4 weeks so you are having more persistent problems than most. If those symptoms persist and you rate them as annoying (which they sound like) then a discussion with your HIV providerabout switching to an alternative drug (such as nevirapine or a boosted PI or raltegravir) may be warranted. KH

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