Question
Are there new drugs and why are old ones still used?
17 October 2016. Related: Access to treatment, All topics, Side effects.
Are there any new drugs since 2000? If so, why do HIV consultants continue to prescribe old drugs despite reports of severe side effects?
Answer
Hi
Thanks for your question.
You didn’t say which country you are in, but every country has seen many new drugs prescribed since 2000.
Very few older drugs are still used in most countries.
A few exceptions are lamivudine (3TC) which has very few side effects.
Another is efavirenz, which is good at treating HIV but definitely has more complex side effects. In countries where efavirenz is still prescribed – including the UK – this is because it is now a very inexpensive drug. If someone gets side effects though, they should have the option to change to alternative.
This link has more information about UK drug choice including costs:
https://i-base.info/guides/starting/nhs-changes-and-generic-drugs
So overall, this is for cost.
Hi Gary, thanks and I hope everything goes well on Thursday. You definitely should be given more modern options got treatment as this combinatin has not been recommended for many years. You are decribing many problems that could easily get better if you switch to a recommended conbination based on an integrase inhibitor.
Please say that i-Base suggested this too if it will help. I am shocked that you are still on this combination. I edited your post as it was quite long, If you want more personal responses after Thursday, please email me here:
questions@i-base.org.uk
I’ve been on Efavirenz for 27 years since 1999 with slight changes concerning other medication but I’ve had so many episodes of wasting.. even though my GU Doctor is looking at me and said that is not a thing anymore..
I’ve got some nasty lesions on my hairline and my scalp.. I wake up very often with terrible sweats.. I find I’m getting cramped a lot …and loss of appetite and just feeling washed out all day.. and I’ve got more lesions around my hairline yet again and I’m going to ask to be changed over to injectables every eight weeks because my body can’t stand this much more.
I have to walk through the pain because my feet hurt so much and I’m getting really weird dreams which I thought only happened at the start… but look how long I’ve been on these… and I believe only 2% of people in the UK are taking these now.
I’m seeing her on Thursday this week and I’m going to have it out with her… because they know I’m having a lot of problems and still they don’t do anything…. I keep getting herpes simplex on my backside my left hand is swollen. The joints in my toes are killing me. Sometimes the pain is unbearable and dreadful cramps and she knows all this… so I’m going to have to take the high ground when I see her on Thursday… because I’ve had quite enough of being poisoned because that’s what it feels like now …maybe be back in the early days it was a lifesaver but not now because the side effects are dreadful.
I’m grateful I’m still here but then again they should have updated my combination …and hopefully I will be offered the injectables as I’m gagging on the tablets at night because they’re so big and I’m nearly 70 and to think when I was first diagnosed in my 40s they gave me five years to live.
I’ve got to do this to be put on another regime and my endurance has been 100% over the past 27 years and I’m in a dreadful state. The weight is coming off again and it’s not a thing is she talking about? I’m quite angry, but I will keep it together and I will make sure she knows exactly how I feel. I have tried in the past and she just dismisses me not this time otherwise I will go to Southampton and see another doctor because I’ve had enough.
PS my CD4 is well over 300 and I’ve been undetectable for 27 years so I’ll let you know how I get on after I’ve seen her Thursday morning, which I’m not looking forward to…
Hi Amy, your doctor is right. Efavirenz does need to be taken at night to reduce the dizzy feeling that is one of the side effects. As long as your CD4 count is under 200 copies/mL, the treatment is all still likely to be working. I can’t comment on the pain without more information, but this is something to tell the doctor about. Even if this combination needs to be changed, nearly all countries now have second-line treatment. In practice though, most people stay on their first treatment for many years.
Please I have being taking efavirenz and truvada combination when I started my cd4 increased to 523, 436 and now 245 because i changed to morning dose and my viral load from <20 now 46 though I eat well but always have stressful days. Now my doctor said the drugs r made for night and I should change my timing which I started immediately but I have started experiencing little pains as in before I was diagnosed. What am afriad is what they called second line, when the first line fails. Is there anything like secondline of is just for me to change drugs? Thanks