high bilirubin & Reyataz, fatigue from Truvada ?

[madbrain]

My bf has been on Reyataz (as well as Norvir & Truvada) since last December. Yesterday, he got his latest lab report in the mail and the doctor noted that all was OK, except for elevated bilirubin of 6.1mg/dL from the med. The normal range is listed as 0.2 to 1.2 .

I looked up this bilirubin problem and this seems to be a common side effect of Reyataz which is why the doctor screens for it. The info I found says also it causes yellowing of the skin. I hadn't noticed that so much - my bf is asian and his skin is naturally yellow - but he says he has noticed that and his skin used to be whiter.

He is going to a follow-up apointment with the doctor on monday because he wants to stop the Reyataz due to these issues. I'll be there with him.

My bf used to be on Atripla (Sustiva + Truvada), which he had switched away after 9 months from because of fatigue and some bad labs (one went down to 200).

It seemed to me that his fatigue had been less since the med switch. It was obvious to me that Atripla was causing his fatigue before - on the rare occasion when he had missed his med, the fatigue wasn't there.

Since the Sustiva was known to cause some fatigue issues in some people, the doc had switched his atripla to Reyataz / Norvir / Truvada (really just replacing Sustiva with Reyataz+Norvir) last december.

But my bf says the fatigue as far as he is concerned has been just as bad with the new combo as the old one. Labs wise, he has always been undetectable regardless of the med. His CD4s have been more stable with the new combo than with Atripla, but they still can never best 400 and usually closer to 300. At least no dip in the 200s.

These med issues seem like going from charybdis to scylla .

To make a long post short, my bf wants to go back on Atripla.
Now, I am not the one who has to swallow the pills, but I hated to see how tired he was with it.

Since Truvada (Emtriva + Viread) is the common part of both combos, is it possible that it's actually that med causing his fatigue ? Does anyone else have experience with that ?

[weasel]

I am on the same HARRT meds !

 I have NO ill effects !

 OK , a belly issue every three days 

  I have NO fatigue from any of these drugs ,been on them FOUR  years .

 Does your partner take anything for high bloodpressure ?

 You need to revue ALL that he is taking .

 I do NOT think it is the  Truvada , Reyatz , Norvir  .

                                     I wish you both well 

                                                                        Karl

[madbrain]

I am on the same HARRT meds !

 I have NO ill effects !

 OK , a belly issue every three days 

  I have NO fatigue from any of these drugs ,been on them FOUR  years .

 Does your partner take anything for high bloodpressure ?

 You need to revue ALL that he is taking .

 I do NOT think it is the  Truvada , Reyatz , Norvir  .

                                     I wish you both well 

                                                                        Karl

The only other medication my bf is taking besides the HAART is 20mg celexa for depression. He doesn't take anything for high blood pressure.

We went to the doc together on monday. He said the high bilirubin is a known side effect of the Reyataz. He said my bf didn't look jaundiced. He said he would always take a patient off Reyataz if the bilirubin level reached around 10. In the case of my bf, he didn't think the bilirubin level would stay at 6 because several of his previous levels were lower (though still above normal).  So, he thought it was OK for him to stay on the Reyataz for now.

But my bf said he would rather go back to the Atripla so that he didn't have to worry about that side effect. So the doctor obliged and put him back on that. My bf switched back monday night. So far so good, but he will have to get his next lab checked in one month to make sure the switch is OK.

[Assurbanipal]

Hey Madbrain

You've probably already checked this out, but it could be the fatigue is an HIV symptom rather than a meds issue.  There's a lot of threads on fatigue.  Might it be worthwhile for him to check testosterone levels with his next labs or maybe have a depression screening?  Especially since he said he still felt tired on Atripla too (even if he manifested his tiredness in a way that didn't trigger for you)  and... didn't you mention something about libido in a prior thread?

Best wishes  -- hope you and he can find a solution.
A

[madbrain]

Hi,

You've probably already checked this out, but it could be the fatigue is an HIV symptom rather than a meds issue.  There's a lot of threads on fatigue.  Might it be worthwhile for him to check testosterone levels with his next labs or maybe have a depression screening?  Especially since he said he still felt tired on Atripla too (even if he manifested his tiredness in a way that didn't trigger for you)  and... didn't you mention something about libido in a prior thread?

Best wishes  -- hope you and he can find a solution.
A

Thanks.

Yes, I asked the doc to check his testosterone level a year and a half ago, soon after he started the atripla and started being tired. It was normal. I had some fatigue issues too, but more transient, so I got mine checked too. I think his testosterone level was higher than mine actually.

I don't know if the lack of libido and fatigue have the same cause. They may very well be separate.

Regarding his fatigue, it's hard to say how much is med-related and how much HIV-related. My bf didn't have HIV very long before he started med since he had been a very fast HIV progressor. In May 2006 he tested negative for HIV. In November 2006 he tested positive, with tcells of 300 and 13%, meaning he had AIDS according to CDC. His VL was only 4k. His tcells dropped to 230 and 9% in January 2007, and VL increased to 30k. He went on Atripla in March 2007. He would have gone on meds earlier if the Santa Clara county clinic did its job timely and didn't hold its genotype test for a full 2 months. I can tell you that the week he started Atripla, he got sick with shingles. The docs said it was probably unrelated to the meds. They didn't check his tcell count just before he started. It might have dropped some more and caused him to get shingles even if he didn't start meds. We'll never know. In any case, he started being much more tired from then on. I have anecdotal evidence that when he missed his Atripla around October 2007, he felt great and was running around like crazy. Until I noticed it and reminded him and he took his missed dose. Then he dozed off immediately. Then, his tcells dropped to 200 in November, his lowest recorded number, and the doc switched him to the other combo with Reyataz in early December 2007. He had been on that for almost a year before he got switched back on monday. Obviously, with the kind of HIV response he has had, it's clear that my bf needs to be and stay on HIV meds. The doc could not afford to take him off meds to find out if it's the med causing it. The best that can be done is switch meds.

Regarding libido, when my bf tested poz, his libido went down, I'm sure from depression. Since that, he has been on anti depressants. He was on paxil first, but that made him gain weight, so he switched to celexa. But celexa is known to lower libido in some individuals. That could be the reason for his low libido. He has been on 10 to 20mg celexa for 2 years. I was on 60mg celexa and a horndog. My celexa just got lowered to 20mg. I'm still a horndog. That med just doesn't seem to affect my libido. But everyone is different.