It would be unusual to have to stop ART for a week because of surgery. A day or two maybe, but except in the case of major abdominal surgery, a week would be unusual. It often takes two weeks or more for the viral load to rebound, so even if you were off for a week, your viral load might very well remain suppressed.
I’m taking a wild guess here, but I’ve received three questions in a row asking about bad things that might happen to someone with an undetectable viral load. I suspect they call came from you. Anxiety is a treatable condition!
I don’t like to say this , but your doctor is quite wrong. The longer a regimen works, the more likely it is to keep on working. When failure occurs, it typically occurs early because of poor adherence. People whose viral load remains undetectable after a year or two are the adherent ones, and there’s no reason their regimen would ever fail.
That being said, Combivir has AZT in it, which can have significant long-term toxicity. Therefore, while there’s no reason you should ever need to switch because of failure, I hope you’ll eventually switch to prevent side effects.
Yes, and no.
The Stribild interactions are similar to the Norvir interactions, which were scary at first. Eventually we became familiar with them and learned how to work our way around them when necessary. I can’t generalize about drug interactions because the details depend on the medication, but here are some of the ones that come up most often:.
1. Statins: if using atorvastatin (Lipitor) or rosuvastatin (Crestor), start with low doses (10-20 mg). Pravastatin (Pravachol) is safe, but it’s a less effective drug. Don’t use simvastatin or lovastatin.
2. Steroids: Avoid fluticasone (Flonase, Advair). Of the inhaled or nasal steroids, beclamethasone (Beconase AQ, QVar) is the safest. Avoid having steroids injected into joints if possible
3. Benzos: I hate them all, with or without Stribild, but avoid triazolam (Halcion), which is rarely used these days. Midazolam (Versed) is used only as an anesthetic for surgical procedures. Mixing Stribild with midazolam can result in a very long nap and should be avoided.
4. Rifamycins: If you ever needed to take rifampin or rifabutin for TB or some other reason, you’d presumably be under the care of an infectious disease doctor, who would know about the interactions with Stribild.
5. Blood pressure medications: While not absolutely contraindicated, I generally avoid calcium channel blockers (amlodipine, nifedipine, diltiazem, verapamil) if possible.
If you look up “fever” on Wikipedia, you’ll find that 37.5 is not a fever, it’s in the upper end of the range for a normal temperature. There are other things to worry about at nigh time, like monsters under the bed.
In the developed world, the idea of “late stage” HIV/AIDS has become a somewhat obsolete concept: We help people by not letting them progress to that stage in the first place, or by treating them so they recover. However, I remember all too well the pain and suffering that people experienced in the bad old days, and people in resource-limited settings may still progress to develop advanced disease because of lack of effective therapy.
The are a number of palliative treatments for pain. Drugs like gabapentin, pregabalin, and tricylic antidepressants can treat neuropathic pain, and opiates (e.g. oxycodone, morphine) should be used to treat pain that isn’t controlled by other measures. The importance of providing appropriate palliative care in resource limited settings has become a global priority.
There are no specific drug interactions, but you always have to be careful taking this kind of medication (non-steroidal anti-inflammatory drug) when you’re taking tenofovir (a part of Atripla) because both can hurt the kidneys. Avoid high doses and get your kidney function checked regularly.
It’s hard to answer wiithout knowing his viral load and where his CD4 count was before.
I think I just answered this question a few days ago. Scroll down!
I generally avoid answering questions about drug interactions because the number of combinations you could ask about is virtually infinite, and this information is all available on-line (see http://www.hiv-druginteractions.org/). But when you ask a question about drug interactions and you don’t tell me which HIV meds you’re taking, then I lose all motivation!