Ask Dr. Kaiser

Question:

I've read your book and I've been following your vitamin protocol now for several months. I received my last lab results. My VL went from 68,000 to 700,000 and my CD4 went from 131 to 151 (strange that they went up!).

Anyway, I've waited and waited to go on meds and I finally made the decision with my doctor to start. It was because of your book and trust in you that I finally did this. I started 3 days ago: 3TC, Viread and Sustiva. The first day when I woke up (I take the Sustiva at night) I felt drunk and disoriented. It scared me. The next day I felt better. Here are my questions: 1. Do you feel that this combination is the right one? 2. Will the feeling of disorientation, uneasiness go away in time? How much time? 3. If I have to change from Sustiva, what would you recommend? Can you change after only taking a med for 1-2 weeks?

Thank you, Mark

Dr. Kaiser replies:

Dear Mark: Because your CD4 count dropped so low, I'm glad you found the courage to start antiviral medications. Once the CD4 count falls below 200 cells/mm3, a person is at much greater risk for a serious infection to occur.

The combination of Viread, 3TC, and Sustiva is a very good one that I prescribe frequently so I agree with your choice of meds. Your question deals with the type of side effects that one can develop at the onset of starting Sustiva. The research shows that 50% of people who begin Sustiva will develop some kind of nervous system side effect (such as drowsiness, vivid dreams, anxiety or depression) during the first few days or weeks of taking the drug. That is why it is good to start this medication before a quiet weekend at home and not the night before a big business meeting. The side effects can last a few days or weeks in most people but over 90% of the patients who start Sustiva are able to continue taking it, mostly because the majority of side effects will resolve on their own within a couple of days to months. Patients can also benefit from treating the anxiety or depression that may occur with medication in the short term.

It is worthwhile to give Sustiva a try because it is a very potent antiviral drug that can work well for a sustained period of time. Finally, if the side effects become unmanageable, you can stop the Sustvia and start a similar medication from the same class (Viramune) the very next day without skipping a beat.

Good luck and let me know how you do!

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