Question
What shall I switch to?
10 November 2009. Related: All topics, Changing treatment, Pregnancy.
My husband and I would like to start a family. About a month ago I switch from efavirenz (Stocrin) to nevirapine and after three weeks my liver enzymes increased dramatically and after another week had further doubled so my doctor recommended that I switched back to efavirenz until things stabilised.
As soon as possible (at the latest Monday) I would next week like to switch to a new combination so that I can start the process of being in a position to fall pregnant. I have been looking at the April 2009 Recommendations for Use of ARV in pregnant women and am trying to make sense of it all.
My current medical history ? I have been HIV positive for 15 years, on ARVS for around 7 years ? first Combivir and efavirenz ? then switched to Truvada and efavirenz to make life easier and now need to make a further switch ? CD4 count is always over 500 and viral load has been undetectable for the duration of my treatment.
Can I ask advice on:
– What would be the best combination to switch to now?
– How do I make that switch?
– What side effects should I expect?
If I switch to a protease Inhibitor ? can I switch back to efavirenz later on. ? I am completely nervous of the long term effects of PIs. I have heard that I will not be able to switch back form one doctor and that I will be able to switch back from another.
Thanks – I appreciate your support.
Answer
Hi
You are right that the best thing to do is to substitute the efavirenz for a
boosted protease inhibitor.
The choice of which PI will be up to you and your doctor, but currently lopinavir/ritonavir which comes in one pill called Kaletra is one that is widely used during pregnancy.
Side effects that you may experience include nausea and other stomach-related effects (bloating, gas, diarrhoea) but these are usually mild and manageable.
You will be able to switch back to efavirenz after you have your baby. It sounds like you have an excellent treatment history.
Good luck with your treatment and your pregnancy and please don’t hesitate to contact us if you have any more questions.
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