Hi Pozziepinoy.
I am completely distraught by my situation right now. I got my HIV positive result last Jan 8, 2013 in PGH-SAGIP. I am 32 years old, male, opted not to work for the meantime. Im living with my girlfriend, who luckily has negative HIV screening result last Jan 15, 2013. My parents and immediate family members in the province don't know yet my situation.
Prior to HIV revelation, I had this high risk pneumonia in March 2012 and PTB diagnosed last Sept 2012. I stopped working since then to give way to my immediate recovery. I'm done with Myrin P Forte medication, and started Myrin until May 4, 2013. I responded very positively to my PTB treatment; prior to treatment I weighed 55kgs; last Jan 8, 2013, it registered 61 kgs. I experience no other diseases like flu and fever during my treatment except for adverse reactions like itchiness, stomach upset and rashes.
Meanwhile, I felt so disheartened when my first CD4 count on Jan 15, 2013 was 12 only. I consulted my ID Doctor and he required me to start the ART ASAP even while taking my PTB medicine. I started last Jan 22, 2013 at 11 PM, 3 ARVs- 1 tab Efavirenz 600 mg., 1 tab Tenofovir Disoproxil Fumarate 300 mg., and 2 tabs Lamivudine 150 mg each. At 6 PM, before dinner, I am taking my Myrin.
My Pulmonary Doctor who is in the private hospital and ID Doctor in PGH-SAGIP think of the possible drug interactions. The latter said that I might get fever also due to interaction of ARVs with the virus. Looking at MIMS, efavirenz is altered the effecacy by rifampicin, one of the ingredients of Myrin. I need to finish my PTB medication to avoid relapse; need to visit my Pulmo on Weds for possible replacement of my PTB medicine.
Last Friday night, Jan 25, 2012, I started to feel the adverse reactions. I don't know if it's the effects of drug interactions. Initially, I felt body pains and headaches. Starting last Saturday until this writing (Jan 28, 2013) I experience fever upto 38 deg. cel., chill and at times with body pain, abdominal pain which is tolerable, rashes and abnormal dreams. I self-medicate my fever using biogesic tab or if with body pain I take alaxan FR. I will visit PGH-SAGIP next Tuesday as scheduled, but doubting now the effect to my ART the taking of biogesic or alaxan. I am taking motilum also 30 mins before meal to avoid vomiting/ stomach upset. Are those practices have adverse drug reaction to my ART? Should I need to stop taking analgesics and motilum? Up to when fever will stop? I lose my apetite too. I feel so devastated right now. Please help.
God bless,
XXX
CONTRIBUTOR'S RESPONSE
Dear XXX,
Based on your account, the symptoms that you are feeling right now, I believe are more related to the reactions of your body on the ARV that you are taking in rather than the drug-interactions with Rifampicin. There is indeed a drug interaction between Efavirenz and Rifampicin but it is related to the perceived increase clearance of Efavirenz with concurrent treatment of Rifampicin. It means that the Efavirenz may become less effective with intake of Rifampcin BUT a lot of data DO NOT warrant to increase the dosage of your Efavirenz for it to be effective while you are taking Rifampicin, but only your HIV specialist can decide about the dosage adjustments.This interaction will not normally result to fever, rashes, stomach upsets, etc as this is related to drug absorption. Just to emphasize ,that what you feel right now are not exactly related to the combination of Rifampicin and Efavirenz. For this point, do continue to take BOTH medicine.
It's a little bit unfortunate that your CD4 count is at 12. I will just be straightforward that this is AIDS, and the virus has been with you for sometime, but the good thing is, you are already on ARV, so it should be a good step. I do not really think that taking analgesics and anti-motility drugs can cause adverse drug interactions with ARV but I am more worried with the self-medications that you are doing. A little learning is a dangerous thing. Here are the things that you can do:
1. Be in close coordination with your HIV specialist if you can have an earlier appointment as you seem to have the nasty side effects of the ARV. You can minimize taking those analgesics and anti-motility if you can have an immediate follow-up very soon so they can adjust your ARV and evaluate you further. If this is not possible, try to see your pulmonologist as soon as you can.
2. DO NOT stop taking the ARV for now, its very important to keep your HIV specialist updated about your conditions.
3. Try to keep your environment and any food intake as clean as possible as your CD4 count is very low, it is best to avoid going outside if not necessary and wearing a mask will definitely helps.
Just be persistent as you are on the very early part of the treatment and if you have good adherence then you are on your way for a much healthier condition soon.
Regards,
Phillip Tjr (MD)
Philippine Contributor
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