May 8, 2012
Dr. Henry: I was first diagnosed in 11/2011. I am 57 years old. My lowest CD4 was 322 with 17% lymphs. Current CD4 is 510 with 33% lymphs. I first started on Atripla but had to stop due to severe rash (wrote to you earlier about that). I take frequent antacids so Complera wasn't a good option. Then I tried Epzicom/Isnetress but Epzicom caused severe stomach pains and my doc tested me for pancreatitis. Blood tests were OK (lipase and one other test). Since 2/14/12, I have been taking Truvada/Isentress. My last VL = 68. It was 46000 at first diagnosis. The results on the most recent VL taken May 1 have been delayed and are pending at the lab. The problem I have with the Truvada are CNS side effects. In the past I have had episodes of depression and PTSD. The Truvada seems to make those issues worse. I feel very fatigued especially first thing in the AM. 1. Would it be extremely harmful if I temporarily stop the meds for 2 weeks to a month to see if I feel better? 2. If I have to permanently change the Truvada, what would the next medication options be? I know you have said that Truvada/Isentress is usually well tolerated. Physically, I do fine on it but it's the CNS side effects. This is why I wanted to stop temporarily to see if there is marked improvement in how I feel. ( I am not currently taking any SSRIs.) Thanks for reading all of this. Ron
Response from Dr. Henry
I would discuss with your provider-changing the Truvada to Combivir for a month or so might be a reasonable option (you have been unlikely with the side effects of Epzicom and Truvada--maybe you would do OK with Combivir for a while). Once you are undetectable then perhaps other options could be considered (ie a boosted PI regime with raltegravir). Starting and stopping meds can be hard to sort out what all is going on so I usually prefer switching off offending meds to attractive alternative. KH
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