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Peripheral Neuropathy of both feet
Sep 8, 2000

Dear Dr.,

I have contacted you before on this condition of mine and you have been most helpful.I have had a RMI of the lumbar spine as you have suggested but nothing relevant to the Symptoms showed up(as you anticipated).

I now have to ask you about Sustiva(efavirenz). I hear that it is quite a potent drug and that it can get into places such as the nerves/Mylien sheath,where other traditional anti HIV drugs cannot.

I think that the virus is still harbouring in this area and causing me severe discomfort,despite my non detectable status and High CD4 counts(1000 plus).

Please would you comment on Sustivas ability to penetrate the nerve area.I would appreciate it very much as I am trying everything to get a little relief.

Thanks a stack.

Response from Dr. Boyle

Sustiva has been shown to penetrate most areas of the body well, including the central nervous system. I am not sure, however, that continued viral replication is the source of your neuropathy. I would have your doctor check to make sure you are not on any neurotoxic agents (including one of the "d" drugs) and that you do not have a metabolic or other reason (including vitamin deficiency) for your neuropathy. You may also want to see a neurologist for further evaluation. Finally, there are many treatments for neuropathy (many of my patients have had a significant improvement with Neurontin) and you may need to discuss those with your doctor if the cause of your neuropathy cannot be found and eliminated. BB

Brian Boyle, M.D., J.D.

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