I was first diagnosed in 12/95 and started a simple 2 drug combo of AZT and 3TC. I was on that combo for 10 years. My CD4s ran consistently in the 500-900 range and my VL always < 5000. After a genotype test showed resistance to the 2 drugs and a CD4 count of 300 and VL of 5500, I decided to switch to a new combo. I've switched to 300 mg Reyataz, 300 mg Viread and 100mg Norvir (AM) and 600 mg Sustiva (PM). First test showed a CD4 of 353 and VL of 130. Second test a CD4 of 459 and an undet. VL. I started this combo in March 2006. Here it is 6 months later and I think I'm having one heck of a time with the Sustiva. I have all the classic side effects - fuzzy feeling, anxiety, insomnia and a new one to me, depression. I'm normally upbeat (believe it or not) ALL the time. Lately, I feel like I'm in a super FUNK ALL the time. I'm seriously considering switching to Viramune or Rescriptor to see if the CNS side effects go away. Should I switch the other drugs at the same time or continue using those and just switch out the Sustiva? ANY suggestions would be greatly appreciated!! Ron

Hi Ron, Thank you for sharing your situation. The good news is that your viral load is suppressed and you have great CD4 cell numbers. Without knowing more about your resistance pattern it is a little difficult to advise you but I can make some general comments.

It does sound like your symptoms might be related to Sustiva. It would be good to know if they developed right away upon starting this drug, and have persisted, or if they have come on more recently. In general I would expect these kinds of side effects to have come on right away if it was from sustiva.

Assuming you discuss this further with your provider and you both agree that this is likely to be from Sustiva then I think you have a few viable options. One, as you point out is to switch to viramune, an alternative NNRTI that doesn't cause these types of side effect. The problem with this is that men with CD4 cells greater than 400 appear to be at greater risk of significant side effects from viramune, particularly rash and liver inflammation. There is much less data with Rescriptor, a drug that is rarely used so difficult to recommend. Nevertheless, possibly an options.

Another consideration is whether you even need to be continued on a NNRTI, such as sustiva. If you have some NRTI activity in your regimen it may be that this along with a ritonavir boosted PI may be sufficient to maintain viral control.

These are just some ideas for you to consider. Talk it over with your HIV provider and give it some thought.

Best, Eric