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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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sleepiness side effect?
Jul 11, 2001

I have been HIV+ and healthy for 14 years, and have been on Zerit, Ziagen, Norvir, and Fortovase for the past year. Viral load is <50, CD4s are 450. This past year I have been increasingly sleepy and lethargic all day long. My body is producing powerful chemical signals to sleep whenever I sit down, but I am NOT fatigued. In fact, in the middle of the day I can only sleep for 5-15 minutes at a time because I simply am not tired. If I keep moving, I have plenty of energy and can go all day long. The National Sleep Foundation refers to this as Excessive Daytime Sleepiness (EDS). I have never seen this described anywhere as a side effect, yet it's hard for me to believe this could happen without some kind of trigger. Any thoughts? And any information on whether modafinil (Provigil), which is used to combat EDS, might interact with the HAART drugs I am taking?

Response from Dr. Bartlett

I am not aware of excessive daytime sleepiness being related to antiretroviral therapy, but if the temporal association is strong you should consider altering your regimen with your health care provider. I have never prescribed Provigil, but the 2001 PDR describes its metabolism in detail. It is mainly metabolized in the liver, is an inducer of the P-450 3A4 cytochrome, and a reversible inhibitor of CYP2C19. Translation; there is significant potential for drug interactions with Norvir and Fortovase. I would strongly suggest consulting with a pharmacologist before starting on this medication.

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