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Switching Sustiva to Viramune
Jan 27, 2010

Hi Dr,

First of all greetings from Thailand.

I am on Sustiva, 3TC and Viread for 5 years now. Started treatment with CD4 252 and VL 30.000. Since the start of medication undetectable and CD4's in the 700 range. Since the start 5 years ago I am having problems sleeping, dizziness and all the other CNS problems related to Susiva. I always thought that I would have to bare this just for the sake of the good treatment effects regarding VL and CD4's but since a few months I am really getting fed up with this. My quality of life is terrible and I want to change.

But since I live in Thailand there are not so many "affordable" options. PI's are really expensive except for Kaletra (aluvia). Insentress is available but also far to expensive.

So I have 3 options. The first one is switch to Viramune but I read some information that it might be problematic if your CD4's are over 400, but I also read a recent report from Holland that showed that this would not be a problem for "most" people IF you started your first regimen, other than Viramune, with a CD4 count below 400. Is that correct? If this is the case, should this be a good option for me?

The second choice would be a switch to Aluvia (the heat stable version of Kaletra) but I rather keep the PI route available for a later stage.

The third option would be to lower the Sustiva dosage to 400 mg instead of 600 mg (I am male, skinny and only 55 kgs). I read some recent reports that 400 mg is just as good as 600 mg but with less side effects. I am a little bit reluctant to this option because there is no test here available to test the Sustiva levels in the blood.

I would be very grateful if you could shed some light on above mentioned options.

Many thanks for your great support,

Steve

Response from Dr. Henry

Excellent questions--I am encourage thatd you have some alternative choices in your location--hope those expand in the years ahead. Switching to nevirapine with careful clinical/lab monitoring may be your best option. Nevirapine-if tolerated during first months-is a good drug with a very favorable metabolic/lipid/fat profile would preserve (as you note) other future options for you. KH



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