Hi. I Was Diagnosed With HIV In The Middle Of

Posted on Thu, 11 Jun 2020

Question: Hi. I was diagnosed with HIV in the middle of March this year. At that time, test results indicated that my CD4 level was 154. I began ART treatment soon afterwards, first with Efavirenz, Lamivudine, and Tenofivir. About 10 days after beginning treatment I had an allergic reaction (a painless red rash across my arms, shoulders, and torso). I stopped treatment with Efavirenz and began treatment with Aluvia (Kaletra) 400/100 (two pills twice a day, once with boosters) immediately afterwards. For he first two weeks of treatment with Aluvia (Kaletra), I experienced frequent diarrhea. My doctor suggested reducing my dosage from 400/100 twice a day to 200/50 once a day (one pill with boosters once a day). I want to get a second opinion about whether or not this dosage will still provide effective treatment.

Answered by Dr. Sankaranantham Murugan (3 hours later)

Brief Answer:
Inadequate ART result in poor viral suppression

Detailed Answer:
Hi,
Welcome to Ask A Doctor.
Thanks for posting your query.
In majority occasions, the Effavirenz rashes will settle within a week or two. If the rashes weren't posing severe rashes, you could have wait for few more days.
Regarding the dose of Alluvia, when you reduce the dose like this viral suppression would not be adequate and there is every possibility for the development of drug resistance and you will go for viral and immunological failure. After a day, you continue the original dose of Tab. Alluvia. If loose motion persists, treat for that condition (opportunistic disease), as your CD4 count is low. The present preferred first line drug is Tenofovir, Emtricitabin or Lamivudine with Dolutegravir. Fixed dose single tablet is available. Less toxic. High efficient.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sankaranantham Murugan (51 minutes later)

Thanks for your fast reply. When I brought the diarrhea to my doctors attention I was told that my diarrhea was a side effect of Alluvia, not any other infections. I should also mention that since my CD4 count is so low, I've also been prescribed Sulfamethoxazole tablets (160 mg once a day) to prevent opportunistic diseases and was told after my blood test last week that everything was fine. I've been following this doctors suggestion for a little more than a month. 1)Is it possible that I've already become resistant to this medication? Also, 2)you're saying that I should continue to take the full standard dose of Alluvia and if I experience diarrhea again, consider changing medication?

Answered by Dr. Sankaranantham Murugan (22 minutes later)

Brief Answer:
Resistance to Lopinavir /r cannot be ruled out

Detailed Answer:
Hi,
Welcome back.
In spite of you taking the tab. Cotrimoxazole prophylaxis, still I cannot rule out the cause loose motion due to opportunistic infection. Did the loose stool stop after you had reduced the dose of Alluvia?
One month reduced dose, we cannot rule out the possibility of resistance to Alluvia. But it has a high degree of Genetic barrier for resistance when compared to other drugs.
What are other drugs you are taking with Lopinavir /r?
If you are my patient, I would prefer to switch over to better combination.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sankaranantham Murugan (3 hours later)

Yes, since reducing the dose I have not had any problems with diarrhea. In addition to Alluvia I take Lamvudine and Tenofovir once a day. Also, like I previously mentioned, I take sulfamethoxazole (not cotrimoxazole prophylaxis) once a day as well. When I initially talked to my doctor about this issue, I thought that the antibiotic was causing the problem because I take it during the day and only had diarrhea during the day.

Answered by Dr. Sankaranantham Murugan (4 hours later)

Brief Answer:
Suggested drug resistance test.

Detailed Answer:
Hi,
Welcome back.
Tab. Alluvia is to be used in twice daily dosage. You wrote that you were taking it during day time..Is it so?
Have you seen HIV Viral load before changing it to Lopinavor/r regimen? What was the HIV Viral load previously and the same before starting the regimen with PI.
If you want to continue the same drug, I will advise you to go for ART drug resistance pattern for NRTI, NNRTI and PI drugs. Then decide accordingly. Even virus is susceptible for the Lopinavir, you have to increase the dose slowly to the recommended dose to maintain therapeutic effect for long term.
Dr S.Murugan

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Above answer was peer-reviewed by : Dr. Vaishalee Punj