Is it the Epzicom or Sustiva ?

[budndallastx]

Okay, I just have had an awful week with my meds.  Sunday afternoon, I developed a rash on my legs and arms which I attributed to the Sustiva based on my readings.  On Monday, I developed a slight fever and now today I feel like someone who just had an extensive workout.  I saw the doc yesterday and he wants me to go off Sustiva but these symptoms sound like Epzicom sensitivity.

Now he's talking about a PI instead of the Sustiva.  I get the impression the doctor is just guessing so I have an appointment on the 27th with a different doctor.  In the interim, what do I do?  I have a call into his office to see if maybe switching to Atripla will be the key. 

My tests for mutations came back clean so I am not wanting to do anything that will trigger any type of mutation.  How do you switch from one med to another?

[gerry]

It's hard to say which drug caused the rash because it could be either one.  If abacavir hypersensitivity is suspected, then that drug is the one that needs to be discontinued since that one is potentially serious.  Some can treat through a Sustiva rash, but if it's severe and accompanied by fever, muscle and joint aches, it may be necessary to switch as well.  The problem is deciding which drug is causing the side effect.  Switching to Atripla might be a reasonable option and if the rash continues, then you'd know it's from Sustiva and you can make a decision about switching out of it later.  Something to discuss carefully with your doc.

[budndallastx]

Well the rash got worse and the Dr. took me off all meds.  Now I am sitting here paranoid about a mutation.  The mutation could be with the Sustiva since it stays in the system much much longer than the epzicom.  AM I worrying about something I shouldn't or do I have a quack as a doctor?  Just curious if anyone else had to go cold turkey on their meds? 

Also, what's the proper follow-up?  Do they need to do another viral load and test for mutations?

[newt]

If you had a fever it is most likely the abacavir in Epzicom, but it could also be the Sustiva.

It is important never to use abacavir (Ziagen) again, since the reaction can be much very worse on restarting, fatal even.

Rash etc aside, now you've stopped Sustiva a cautious doc would switch to a PI based combo for the very reason you identified - possibility of resistance to Sustiva (and its sister drug Viramune).  Reported rates are about 50% among people who stop straight out.

But some docs, and fairly perhaps, would try Sustiva again with a different nuke pair, like Truvada (on the basis the problem was down to Epzicom). 

A resistance test a week or so after stopping >may< be useful to spot mutations affecting Sustiva's effectiveness.

Nuke-wise, both the drugs in Epzicom leave the body quickly so stopping them cold turkey is most unlikely to result in resistance-causing mutations.

Good luck

- matt

[budndallastx]

Thanks Matt -

I have been doing my research on the PI's and am terrified of the switch to them since the Sustiva was so easy to adapt to.  THe idea of yellow skin, lipodystrophy and diarrhea are not exactly "user-friendly" reactions. 

Reyataz seems to be the PI of choice at the moment.  If the skn yellows, how long does it usually last ?

Tom