I started on Kivexa and Sustiva 3 months ago, and after an initial bad start with fogginess and bad vivid dreams, things seemed to settle a bit. Now since 3 weeks I am suffering the following: repetitive dreams, more annoying than horrible from which I wake up, always at exactly the same time: 5 0'clock. I have a habit of taking my kivexa and sustiva together 2 hours after dinner around 22.00 hours. After waking up at 5 o'clock i stay awake for what seems forever, not noticing anxiety but resuming sleep until the alarm clock goes at 8 o'clock. my work is very demanding and I cannot feel sleepy and drowsy in the morning -which I do- and I am starting to wonder whether I should a) find a replacement for efivarenz (reading your blog it seems this is the main cause) or b) take the medication at a different time or maybe even cutting my pills in half and spreading them over time. I am quite desperate because the combination is working for me and I had a kidney problem so my doctor told me finding an alternative can be difficult. Please give me your advise. Kind Regards. Great job you're doing. Jonathan -Spain

You could try either taking meds in AM or a much longer time after a meal (fat in stomach can increase efavirenz levels leading to more side effects). Maybe worthwhile checking the efavirenz levels to explose dose modification as an option as well. If your problems persist would consider switch to nevirapine or a boosted protease inhibitor on a trial basis to see how you do with that (assuming suppressed virus levels and no history of significant PI resistance). KH