Time to start the meds.

[peterhelms]

Im writing this with my boyfriend, he doesnt speak english so we are writing this together, we have been together for 4years.
By the way, the little scare we had a couple of months ago when we found out he could have a linfoid tumor  was just a scare, he doesnt have it.
We are a magnetic couple.
His viral load is 65 k and tcell count is 356.
The doctor decided to start now because he has some sinus problems.

The meds that were prescribed are   zidovudina/lamivudina    and  efavirenz.
He will takje 3 pills a day.
Now my questions, i would appreciate it if you guys could answer them in order.
1) the doctor said he is on great shape and should experience any side effects...is that true or the doctor doesnt want to scare us ?
2) Are the meds that the doctor gave him  dated or are they still very much used?.
3) what porcentage of people get fat loss with those meds?
4) what happens if he misses a dose, is it true that the meds might stop working because of it?
5) is it ok if we go on vacation in 20 days?, or should we wait to see how he reacts to the meds?:
6) why does he have to get blood taken a week after starting the meds? is it to check how his liver is coping?
7) Will the  meds help stop the sinus problems? (the doctor seems to think so, and if not stop it, at least make it better.
Thanks so much for the answers....you have NO idea how much we appreciate it.

[komnaes]

Hi Peter,

Starting meds at around 350 CD4 is in line with latest guideline, though some doctors would like to start even with higher count. Do you know his CD4 percentage as well? As for your questions, I will try:

1. Do you mean your doc said he should expect side effects? While talking about side effects we're looking at both short- and long-term - if you read the treatment section here you'd note that efavirenz (more commonly referred to as sustiva here) can cause dizziness, trouble sleeping, etc. So it's often taken at bed time and those side effects tend to go away after a while. However, you should note that it can in some cases cause depression, angry behavior and even suicidal thoughts. So you and him should pay attention to any of those changes and report to his doc if they do appear and become troubling.

2. This combination of lamivudina (more commonly referred as combivir) with sustiva does seem a bit dated as a front line option. Have you asked your doc if truvada (instead of combivir taking with sustiva, which is my regiment) is also available in where you're? Or even the one pill option atripla?

3. If for fat loss you mean lipodystrophy I would say not to worry too much about it now.

4. It's important to be adherence in taking meds, especially during the initial period of viral suppression. My docs and nurses at the local clinic are very straight when it comes to requesting us to take our pills on time (give and take an hour).. once it's become a habit it should not be so difficult anyway. In time anyone of us would miss a dose or two .. it will definitely happen so don't sweat too much about it, but try not to let it happens regularly.

5. With a CD4 of 356 (need to know his percentage though for better assessment), I wouldn't worry too much about a 20 days delay. After all it'd be his decision to when to start at this point when he's suffering any opportunistic infection. I would however definitely not recommend traveling for a long period of time when starting meds.

6. If you don't know what the blood tests are for ask the doctor. He/She may be trying to figure out the base lines of many things so you cannot know unless you ask.

7. With sinus he'd really need to find out what causes it - in some cases it's can be caused by allergies and in some colds. Overall it and other respiratory infections can be more difficult to treat in individuals with more advanced HIV infection, which doesn't seem to be the case with your boyfriend. There are two many things to consider so I wouldn't just take his doctor's words that he "seems to think" HIV meds would help, in a sense that the meds can suppress the virus and allow CD4 to go up again. He does need to look at what is causing sinus separately and treat it accordingly.

Just my inputs. Hope you can get the help you need...