Hi. I live in Australia and am currently taking Viramune/Truvada as a once a day dose in combination for HIV. I am also an alcoholic. My last test saw undetectable viral load, but a sudden decrease in CD4 from 540 to 350 and liver function tests went off the charts. I feel fine though (as good as an alcoholic can anyway). This may have been an anomaly or it may not have been. I have tried everything for alcoholism from counselling to detox to AA type stuff to medications, but nothing's worked; I realize am stuck with both HIV and alcoholism, for better or worse, for now at least. I have no more options left, but don't want to give up either. My question: should I consider switching treatments if my liver function continues to decline and CD4 does not improve, or stick with this regimen anyway, seeing as it has given me an undetectable viral load? I started treatment in Feb. 2010.

Nevirapine can cause acute and chronic liver irritation in some patients which could aggravate alcohol or other forms of hepatitis. Certainly if liver enzymes remain seriously elevated then looking for other causes (ie viral hepatatits, excessive use of acetominophen) and if none found switching off possibly offending meds are options to consider. Efavirenz, raltegravir, or boosted PIs are options to replace the nevirapine for some patients. KH