TRUVADA & STOCRIN just started after pregnancy and born baby

[BKK/HKT]

Start with the facts
We  ( a European men and a Thai Woman ) she pos. , I'm neg. use this account together.
She mid 20th. was not infected testing in Sep. 2008 and pos. tested in Apr. 2009
CD 4 nearly normal and VL not countable less 40
so we think she was infected in Aug. 2008 when she had sex with a ex boyfriend., or from a bloodtransmission , which she got in July 2008 in BKK
Anyhow since we meet each other we had sex nearly every day ( unprotected ), and she got pregnant end Jan. 2009 ( which we wanted ). In Apr. 2009 then the 2nd. standart visit in hospital with a standart HIV and other SD check ups., with the result she is pos.
My same day test was neg.
Many discussions with Docs, but we want to keep the pregnancy and she got a therapy
Zilavier and Aluvia beginning the last 3 month of pregnancy
AZT 300mg 2 times per day 1 tbl. and Aluvia 100/25  2 times per day 4 tbl.
End of the year we got a( until now healthy ) child , and now the medications we got were finished.
The doc said , she suggested a different therapy to continue, and yesterday she started withTruvada & Stocrin . She  eat the first tablets around midnight and this morning she had fever, hurt muscle and bones, throw off food , and was so dizzy, that she nearly fallen down. We called doc and she said the temperature should not come from this medicine, but the rest is normal.
Well, I read a litle bit about this medicines and found them only available in 1 dosage 600/200/300 ( @ least for HIV treatment ).  It makes me a Little bit thinking , my wife she now back to 43 kg and she has to eat the same dosage as for example me ( if i  would have  ) with more than 110 kg ?? In the other medicine I read that the medicine is only developed for people over 50 kg.
Is this different with the new medicine ?
Or are there any other  Lady's out there  with low bodyweight, and them can give some suggestions
Thanks
BKK/HKT

[Inchlingblue]

Truvada & Stocrin (aka Atripla) is well-known for causing some of those side effects, especially initially. There are many threads here that you can see if you search for example for "Atripla" or "Atripla side effects" etc. With most people these side effects get better over time and even go away completely.

One of the moderators here, Ann, has talked about the fact that her partner, who is taking this medication, was tested for the levels in his body in order to determine if he was taking too much and I do think his dose was adjusted. If she sees this thread, I'm sure she'll share her experience. I forget the name of the test.

Keep in mind that your wife should not just stop taking the medications because this could result in resistance. Chances are that what she's experiencing will get better but I think it's a good idea to look into this test that can measure the levels and maybe the dosing can be adjusted.

Congratulations on your new baby!

[John2038]

Hii BKK/HKT,

First at all, sorry for what happen to you, and Welcome to this forum.

Your doc should order a blood test to measure the drug concentration in the blood.

Be aware that Atripla is one of the best combo available, and that your wife will very probably get healthier weeks after weeks and become immunogically (body reconstitution) and virologically (VL US) successfull.

People who are starting HIV treatment for the first time may develop Immune Reconstitution Syndrome or IRS (also called Immune Reconstitution Inflammatory Syndrome or IRIS). IRS can happen as a result of the immune system getting stronger and responding to an HIV-related infection such as Mycobacterium avium infection (MAC), cytomegalovirus (CMV), Pneumocystis jiroveci pneumonia (PCP), or tuberculosis (TB). People may have been treated for these infections in the past or not even know they have them. If you notice any unusual symptoms soon after starting HIV drugs for the first time, let your healthcare provider know right away so you can be evaluated and, if necessary, treated.

Aside the IRS, combos do have side effect from which one can adapt till they become unoticable over the time (from the 6th to the 11th month for me).

To reduce these side effect, typically most of those if not all that you have mention, you must ensure that Atripla is taken on an empty stomach, ideally at bed time. Then you have to be patient for the body to adapt to the drugs. Finally, if the side effects are too difficult to manage, you can considere a switch.

Among the side effects inventoried, they are (See Atripla.com):

*  Severe depression, strange thoughts, or angry behavior have been reported by a small number of patients. Some patients have had thoughts of suicide and a few have actually committed suicide. These problems may occur more often in patients who have had mental illness.
* Dizziness, trouble sleeping or concentrating, drowsiness, unusual dreams, and/or hallucinations are common, and tend to go away after taking ATRIPLA (efavirenz 600 mg/emtricitabine 200 mg/tenofovir DF 300 mg) for a few weeks. Symptoms were severe in a few patients and some patients discontinued therapy. These symptoms may become more severe with the use of alcohol and/or mood-altering (street) drugs. If you are dizzy, have trouble concentrating, and/or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery.
* Kidney or liver problems. If you have had kidney or liver problems, including hepatitis infection or take other medicines that may cause kidney or liver problems, your healthcare provider should do regular blood tests.
* Pregnancy: Women should not become pregnant while taking ATRIPLA and for 12 weeks after stopping ATRIPLA. Serious birth defects have been seen in children of women treated during pregnancy with one of the medicines in ATRIPLA. Therefore, women must use a reliable form of barrier contraception, such as a condom or diaphragm, even if they also use other methods of birth control.
* Breast-Feeding: Women with HIV-1 should not breast-feed because they can pass HIV-1 through their milk to the baby. Also, ATRIPLA may pass through breast milk and cause serious harm to the baby.
* Rash is a common side effect that usually goes away without treatment, but may be serious in a small number of patients.
* Seizures have occurred in patients taking a component of ATRIPLA, usually in those with a history of seizures. If you have ever had seizures, or take medicine for seizures, your healthcare provider may want to switch you to another medicine or monitor you.
* Bone changes. If you have had bone problems in the past, your healthcare provider may want to check your bones.
* If you have ever had mental illness or use illegal drugs or alcohol.

Other common side effects of ATRIPLA include tiredness, headache, upset stomach, vomiting, gas, and diarrhea. Skin discoloration (small spots or freckles) may also happen.

Please click here for Full Prescribing Information on this website, including "What is the most important information I should know about ATRIPLA?" in the Patient Information.


I wishes you good luck to you both. Most of the time again, things improve with time and most of the time, especially when the treatment is started early, people get back their immune system fully reconstitued and continue to live with HIV. Withunderstanding and love ( it always help), you may have a normal relationship, happy and even others kids.

Best wishes

John

[BKK/HKT]

Thank's for the replies.
Actually we not plan to have another baby now ( may be next year ). And then she has to change back to the other combination Zilavir & Aluvia.
After the 2nd. night the sideaffects already much better. No bad dreams and also not so much dizzy. But still approx 38.9 temp. in the nighttime and after 1000mg Paracetamol and another 400 mg 6h later, temp. went down to normal. May be this is something different, flew or so .
So now 00.30 taking the 3rd. time medicine and then go to bed in 30 min.
After next bloodtest I will post results. But CD4 and VL was never a problem ( because very early when detected ).
However, we still live together like "normal couples". I know about the risk to infect myself, but that's ok for me. Test every 3 month and last week still neg.
Doc said with  VL less 40 the chance to infect is very low, but of course still there.
cheers
BKK/HKT

[Ann]

Hi BKK/HKT, welcome to the forums.

As Inch mentioned above, my bf is on 200mgs daily of Sustiva, instead of the standard 600mgs. He worked for a while as an aid worker in Sudan and when he started Sustiva, his nightmares were related to that period in his life and were unbearable. (he woke up EVERY night screaming) At the time, Sustiva was one of the best meds available so rather than switch him, they tested him to find out how much was in his bloodstream. He first went down to 400mgs, then finally 200mgs. He's been on that amount for a few years and has always remained undetectable. He rarely has nightmares now, but he does tend to have periods of mood swings which I believe are Sustiva-related.

The test Inch refers to is called Therapeutic Drug Monitoring (TDM). It may be available at your clinic; you'll have to speak to the doctor about it.

You may find that her side-effects continue to lessen and she won't need to have her dosage adjusted. Good luck and keep us posted.

Ann

[Inchlingblue]

BKK/HKT: Keep in mind, when Ann is talking about Sustiva, this is the same medication as Stocrin, just different name.

[BKK/HKT]

Yes here in Thailand them only have this Stocrin ( efavirenz 600 mg ).
We will try to find out if the lower dosage here in Thailand is available.
The other medicine in combination is Truvada. Contains 200 mg emtricitabine and 300 mg tenofovir.
But now after the 4th day the sideaffects are already much much less. No more dizzy , and no dreams.
But of course if the 200 mg, or any lower than 600 mg dosage is enough, why not reduce. Have to speak with the doc about that.

[Ann]

BKK/HKT, yes, please do speak to your doctor about this. DO NOT start giving her a lower dose of Stocrin without the benefit of TDM.

Keep us posted....

Ann