Question

I am having trouble taking ARVs, when should I start a new combination?

19 June 2010. Related: Changing treatment, Side effects, Starting treatment.

What is the advised time to be off treatment before starting new meds, after 2 lots of meds not working for me?

I was diagnosed as HIV positive in 2004 with CD4 770 and VL: 4,000 and In mid may this year 2010 started treatment with a CD4 of 350 and viral load 154,0000.

I was first put on Truvada and Sustiva and had a bad rash reaction, then I was put on Truvada, atazanavir and ritonavir and had a bad reaction to these, not being able to keep food down. Over a period of a week and a half I was sick 15 times, so my doctor stopped me on these meds on 8th June.

After stopping the meds I had a bad week of constipation and lead to me needing a nurse to come around and give me an enema.

I am only just starting to get back to normal and need to build up my body strength before starting the new meds. My doctor is going to put me on Truvada, atazanavir – but higher dose than before, and raltegravir.

Can you please tell me what timescale would be best to start meds again?

Thank you

Answer

Answer: Simon Collins

Hi

Thanks for your question and for the being able to post the answer online.

I’m sorry that you have had such a difficult time on your first combinations. Although most people are fine, a small percentage of people are unlucky and are sensitive to treatment. Rash occurs in perhaps 15% people on NNRTI combinations – ie using nevirapine (Viramune) or efavirenz (Sustiva).

Some people are also very sensitive to even small doses of ritonavir, which is likely to have contributed to the nausea in the second combination.

There are no ‘best times’ for planning when to start your new combination. Basically, whenever you feel strong enough to restart is fine. You could start one straight after the other if you want to do this.

I hope this new combination works well for you.

Best wishes