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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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sustiva side effects
May 30, 2001

I seroconverted June 2000 and was diagnosed August 2000. I started Sustiva (600 mg) and Combivir at that time (so I have been on them now 9 months). After taking Sustiva before bedtime I get the usual dizziness, unusual dreams, and feeling "drunk" that I have learned to accept. However in the past few months I have this "fever-like" feeling throughout the day yet I dont actually have a fever. This constant hot-flash makes it hard to concentrate and induces fatigue. My vl is almost undetectable and my cd4 ranges 700-900. I am otherwise healthy. My testosterone is normal. My liver enzymes are normal. No other infections present. I get good rest, eat well, and take my vitamins. What is this side effect? How can I treat it? Thank you for your help!

Response from Dr. Boyle

It sounds like the only new symptoms you are having are the feeling of hot flashes and fatigue. These are relatively nonspecific and tough to diagnose, even in person. The persistence of the Sustiva side effects for this long is unusual, but I doubt that it is involved in your current symptoms. Fatigue and malaise can be relatively common with combivir (the AZT component especially) and it is possible that you have some other condition related to nucleoside use (?lactic acidosis), although again your symptoms don't really suggest that. At this point, I would perform a thorough physical exam and recheck your labs, including a mononucleosis test and an endocrine workup, especially thyroid function. You might try tylenol or ibuprofen and see if that helps with the hot flashes, a stimulant (e.g., cylert) or an antidepressant and see if that helps with the fatigue, and a light sedative at night with the Sustiva to see if that helps with the side effects. Good luck.


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