Question
Sustiva and mood changes – is it easy to switch?
27 June 2007. Related: All topics, Changing treatment, Side effects.
Hi,
I have been HIV positive for over ten years and am taking Sustiva (400), Epivir and Viracept. My viral load is undetectable with a CD4 of 600.
I seem to be experiencing side effects mostly from Sustiva. I’ve been on Sustiva for over five years and only recently, in the last year I’ve had mood changes that although slight, are very noticeable to me.
Things that I used to enjoy like long rides, the arts, and writing bring less pleasure at turns. I feel that I have to force myself to stay mentally OK. Sometimes I do not want to go out of the house except to work. Also, as someone who always slept like a log and got up the next morning refreshed, I now have insomnia several times a week.
My doctor is hesitant to switch my medications since I am doing so well overall. I am grateful that my labs come back OK, however, the mental situation is hard to put up with sometimes.
Your thoughts?
Answer
Hi
Your question raises several issues:
Firstly, switching from efavirenz to an alternative drug is easy – especially given the fact that your viral load has been undetectable for so long.
The symptoms you describe could easily be related to efavirenz and they seem to be more than mild, and something that your doctor should take more seriously. Trying another treatment could improve your quality of life and will not risk your good lab results.
Have a look at the answer to this previous question:
The choice of which drug to switch to will include nevirapine (a drug in the same family as efavirenz but without the same side effects) but will depend on your previous treatment history.
Your current combination is fairly unusual because it includes one nuke (epivir/3TC), one NNRTI (efavirenz) and one PI (nelfinavir), and using drugs from three classes is linked with a higher risk of lipodystrophy. The choice of this combination may be because you have resistance to other nukes or for another reason. If you have used this combination for a long time than when changing the efavirenz it may be appropriate to look again at your whole combination, in case newer drugs are now available.
If you live in the UK or Europe (or other parts of the world that uses nelfinavir that is manufactured by Roche) then you will have to change your combination because this formulation of nelfinavir has been recalled.
If your clinic has not contacted you already, please contact your doctor as soon as possible.
More information about the nelfinavir recall is at these two links:
- Question and answer document on the recall of Viracept PDF
- EMEA press release on recall of Viracept (nelfinavir) PDF
It is not clear when we receive web questions where people live – but for this question the answer is linked to use or and access to nelfinavir, as much as just switching the efavirenz.
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