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Ask the Experts about Strategies for Treatment-Experienced HIVers
Hi Dr. I have read about Sustiva Baseline blood test to check the amount of Sustiva in a persons blood. I am on Sustiva and Truvada and my AST &ALT doubles with each blood check. I have asked my Dr. about this sustiva test and she did not know anything about it.She also said that even if the Sustiva amount in the blood was high , she had still not heard of lowering the amount of Sustiva taken. Have you heard of this test and lowering the amount taken?
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Response from Dr. Daar
Thank you for your post.
You are correct that there is some interest in monitoring drug levels to make sure that there is enough drug in the blood as well as perhaps consider modifying therapy for toxicity if the levels are particularly high. That being said, these strategies do remain experimental. There are significant issues related to the reliability of the blood tests currently available in the community and it is still not clear how to best adjust the dose for either low or high levels. Consequently, many experts do not yet believe this should be the standard of care and would be concerned about reacting to levels that may not be reliable.
At this point I would work with your provider to define other potential explanations for your elevated liver enzymes (AST and ALT). If it is concluded that the increase in levels is clinically significant and possibly from Sustiva then consideration should be given to using an alternative agent.
Best,
Eric
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Response from Dr. Daar
