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Sustiva False Positive - CC

Feb 25, 2001

I am currently on Sustiva and will have to take a pre-employment drug test very soon. I read your response where you said that Sustiva can cause a false positive for marijuana. How many days before my drug test should I stop taking Sustiva so that I don't get a false positive for Marijuana? Thanks.

Response from Dr. Cohen

Well, my advice would not be to stop the meds if possible - since some "stopping" might result in a loss of suppression if not done correctly.

There are tests for marijuana that do not confuse Sustiva with marijuana - only some brands do. From what you write, however, I gather you do not want to tell the testers you are on HIV meds - since if they knew, they could simply order the tests that do not confuse these two. And then you wouldn't have to stop.

But if that is the issue - that you don't want to mention HIV meds and thus cannot control which test they do - then you need to discuss with your clinician the issues of stopping. The major controversy is that Sustiva can stay in the body for a week or so. Other meds commonly taken with it do not last this long. So when you stop, you might have a few days with only Sustiva around. And IF your virus rebounds very quickly, in those first few days off, it is possible it would grow in the presence of a small amount of Sustiva, and learn how to create resistance to it by mutating. And if this happens, you could not go back on this combination with the same result.

Now, in studies of those who stop - these conditions are very unlikely - most who have stopped have restarted successfully. Most who stop do not have viral rebounds in those few first days - but it is at least a possibility to consider as you consider this dilemma.

There is controversy in our field about how to handle this. Some clinicians would suggest you just stop - since the risk is low at most. Some would stop the Sustiva a few days before the other meds. Others would stop the Sustiva and at the same time substitute another medication for the Sustiva for a week, and then stop the entire combo. Each approach has pros and cons. So you need to decide which way you want to go with your clnician.

Or else just tell them you are on a med that might show up on a test a marijuana. Bring in the package insert (you can get this from a pharmacist) from Sustiva. Tell them which tests they cannot use reliably on you. Since neither well treated HIV, nor the treatments themselves, has any influence on how well you can do whatever job you're applying for.

Good luck. CC

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