Question

Why doesn’t the doctor change treatment in these circumstances?

21 June 2011. Related: Access to treatment, All topics, Changing treatment, Opportunistic infections, Side effects, Stopping treatment.

I am asking on behalf of a service user who lives in Uganda.

She has been on ARVs for eight years: The present combination she takes is: abacavir (2 tablets), tenofovir (2 tablets), atazanavir (1 tablet), and ritonavir 1 tablets. The side effects include nausea, abnominal pains, vomiting, tiredness.

She wants to ask:

1- Why has her consultant refused to change her medication?

2- Can she get a combination with fewer tablets instead of six tablets ?

Adherence is becoming more and more complicated as at times she goes on up to 3 weeks drug holiday. Thank you

Answer

Answer: Simon Collins

Hi

You question covers lots of different things and I will go through them one at a time.

Please could you check that the information about the drugs and doses is accurate. Tenofovir should only be taken as one pill once daily. If it is being taken as two pills daily this may explain some of the side effects.

Also, abacavir and tenofovir are not usually used in the same combination, because only one is likely to be active. Although it is a technical report,  the study at this link might be useful to show to your clients doctor.

Thirdly, any symptoms should be taken seriously by a doctor in case they are not side effects but caused by another illness. Without your client’s medical HIV history (CD4 count and viral load, drug history, possible resistance etc) it is not possible to talk about other options. In the UK there would be other choices though.

Taking treatment breaks could be contributing to these symptoms. Stopping and starting treatment is not recommended as this can lead to drug resistance. If the symptoms disappear when off treatment though, this could be evidence that the meds are causing side effects and that alternative drugs could be used.

Perhaps suggest your client take a friend, family member or treatment advocate when next visiting the doctor. The docotr needs to know about these difficutlites, includng the treatment breaks, in order to help your best help your client.