switch of medication, any input?

[franfrog]

I went to see my doctor for my routine visit but it was not my regular doctor.  Anyway, he came in and changed my meds and pretty much started walking out.  I had to stop him to get my numbers and did not get a chance to even really ask him any questions.  Well I am currently on combivir and sustiva which has been my combo since the beginning 4 years ago. 
It has worked well and my CD4 has gone from 52 up to the highest of 829 but dropped to 633 last visit.  My vl usually hovers around 70-80 copies and was undetectable last visit.  Why would he think of even changing my combo?  He changed to atripla.  When I spoke to my usual PA who is whom I normally see, she did say it was a good combo.
I hate doctors, I love seeing my PA because she spends the time with me but what do you all think. 
Any input would be helpful.  Also what kind of side effects does atripla have? 

[jennynyc7]

I am certainly not the most knowledgeable when it comes to treatment otpions and such but my first instinct is that that the Dr jumped the gun. I can't believe he/she didn't even talk to you about his reasoning for the switch. Of course we could safely assume it was due to the cd4 decline but how do they know it wasn't just a normal fluctuation? I don't know, seems odd to me.

[aztecan]

Hey Fran,

First, find another doctor. If I were treated like that, I would be chasing the doctor down the hall and not leaving until I had the answers I wanted.

Second, the meds don't do anything for the CD4 levels. That is purely up to your body and a drop like yours is not uncommon nor is it alarming, unless the next round of labs shows yet another decline.

Third, were you experiencing any problems with the former combo? Sustiva is a part of Atripla, so that is a no brainer regarding the switch he "ordered." But Combivir is a good med. Perhaps he was fearful the AZT component would cause you problems.

The bottom line is it is your body. Were it me, I would not allow such a switch unless I were given a convincing reason for it.

But, that's just me.

HUGS,

Mark

[franfrog]

Thanks Mark. 
Did you just ever get so dumbfounded you did not know your butt from your elbow.  I have never been in that situation.  Like I said, I always see the PA and she takes all the time I need with her.  I did put a call in to her and she said it was a good medecine and it was just adding a third one into the mix that I am currently on.  We were not sure actually if we were going to switch.  I was on the fence with the no sleeping and depression but this we were thinking was becaue of the sustiva. 
See I like my combo because it has been working well for me, I just wonder if changing to the atripla will help or make things worse? 

[franfrog]

But Combivir is a good med. Perhaps he was fearful the AZT component would cause you problems.

Mark
The AZT, isn't that also a part of Atripla? 

[newt]

There's no azt in atripla (atripla = efavirenz + FTC + tenofovir)

- matt

[drew50]

It's so easy just to accept what the doctors say and do because that's the way we've been brought up but there comes a time when you have to stand up for yourself and remind them that you're there and that with hiv, you are at the very least entitled to an explanation and a medical reason given in layman's terms. Any questions should also be patiently answered.
Dig your heels in and tell this man how you feel!

[SoSadTooBad]

The doctor's communication issues notwithstanding - I made that same switch about 16 months ago, and it was extremely effective.  Once a day dosing, no more nausea or anemia from the AZT in Combivir.  No better or worse issue with Sustiva and a single co-pay.

[Desertguy]

I have found in my short 16 months of being + that it is important to know as much if not more about the meds you are on than your doctor!!!

There are lots of sites incliuding this one to find that information1