Watiti Foundation LTD

22/10/2019

I can't agree with my partner, and we are all Positive ?

Dear doctor, my husband and I are both HIV positive and have been doing well on ARVs until recently when they were changed from tenofovir, lamivudine and efavirenz to tenofovir, lamivudine and dolutegravir. Fortunately for my husband, he likes the new regimen and is happy but for me I cannot tolerate it. I developed constipation and my stomach is always bloated making it difficult for me to continue taking them and yet when I reported my problems to my doctor, I was told to drink more and eat fruits that would help solve the problem but it hasn’t. I have actually stopped taking it and gone back to my old ARVs because I still had some from the old supply. The old regimen was working for me perfectly well and I am ready to buy it because the new one makes me miserable. Please advise. Sarah.

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Watiti 'Imani' Deborah The New Vision Daily Monitor End HIV/Aids in Uganda by 2030 UNAIDS South Sudan

18/10/2019

Dear Lillian,
Find below what I have worked on for your consideration.
Question

Dear doctor, my husband and I are both HIV positive and have been doing well on ARVs until recently when they were changed from tenofovir, lamivudine and efavirenz to tenofovir, lamivudine and dolutegravir. Fortunately for my husband, he likes the new regimen and is happy but for me I cannot tolerate it. I developed constipation and my stomach is always bloated making it difficult for me to continue taking them and yet when I reported my problems to my doctor, I was told to drink more and eat fruits that would help solve the problem but it hasn’t. I have actually stopped taking it and gone back to my old ARVs because I still had some from the old supply. The old regimen was working for me perfectly well and I am ready to buy it because the new one makes me miserable. Please advise. Sarah.

Answer

Dear Sarah, the right thing to do is to be open with your doctor and tell him or her that you cannot tolerate the new regimen of tenofovir, lamivudine and dolutegravir (TLD), to which many people are being switched to according to the new guidelines. Most people who have been switched to TLD from tenofovir, lamivudine and efavirenz (TLE) are happy but those who have challenges like you need to be listened to. It is true that compared to efavirenz, dolutegravir is smaller (50 mg compared to 600 mg of efavirenz) and therefore easier to swallow, has fewer side effects and has a higher barrier to resistance compared with efavirenz and nevirapine, which means it can be used for a longer time without the virus developing resistance to it. However, like any other medicines, it has side effects including those that have never been documented hence the need for continued pharmacovigilance, which is the practice of monitoring the effects of medical drugs after they have been licensed. This is necessary in order to identify possible side effects not noticed before the drug was licensed. What can be done for you is to give you the optimized dose of efavirenz, which is 400 mg, because it has been found to be as effective as efavirenz 600 mg. However, you should discuss with your doctor this possibility instead of returning yourself to the old regimen without his or her knowledge. Antiretroviral therapy is treatment for life and in order for it to succeed there must be mutual trust between doctor and patient.

Watiti 'Imani' Deborah Stephen Watiti End HIV/Aids in Uganda by 2030 The New Vision Daily Monitor Ministry of Health- Uganda

27/09/2019

Question

Dear doctor, I am HIV positive and have been on ARVs since 2000. During most of this time I was on the same regimen and my viral load has always been undetectactable when checked. However, about nine months ago, I was convinced to change my medicine from what I used to take as one tablet twice a day to one tablet taken once a day. I was reluctant to change because I had got used to my old medicine but since I was going to take one tablet once a day, I accepted. I have now got used to the new medicine but then recently I was told that some people who were put on the same medicine known as dolutegravir have developed diabetes and others have even died. I have had no problems to-date but I am worried. My husband who incidentally doesn’t have HIV is now blaming me for accepting to be put on new drugs, whose side effects we did not know when the old ones were doing a good job and I had got used to them. Shouldn’t I go back to my old medicine? Victoria.

Answer

Dear Victoria, it is commendable that for over ten years, you have been taking your ARVs with good adherence and therefore your viral load is undetectable. This is good not only for you because you will not develop AIDS but also for your husband who is HIV negative. When your viral load is undetectable the risk of you passing on the virus to him is very low. The reason dolutegravir, which is the new medicine replacing the two commonly used ARVs (nevirapine and efavirenz); because it has been found out that more than 10% of people living with HIV have resistance to these two medicines apart from having more side effects than dolutegravir. Based on this evidence both the world health organization (WHO) and ministry of health revised the treatment guidelines and replaced nevirapine and efavirenz with dolutegravir. Dolutegravir contains only 50 mg of the medicine (the active pharmaceutical ingredient) compared to 200 mg and 600 mg for nevirapine and efavirenz respectively. It certainly is easier to swallow, can be used for a much longer time before need for switching but like all medicines, it has side effects but they are fewer compared to nevirapine and efavirenz. For example it has been observed that in some people it raises their blood sugar and so people who have diabetes or at high risk of developing it need to take precautions like knowing their baseline blood sugar before being initiated on it. If it is contraindicated then one can stay on efavirenz but use the optimized dose of 400 mg, because it has been proved that it works as well as 600 mg in suppressing the virus. The main thing is that whoever is put on any new medicine should be vigilant and report any side effects and if they are severe, then the medicine should be stopped. For your case, since you have no problem, continue with the new medicine because there is no need for you to return to the old regimen. Lastly live and eat healthy to avoid putting on excess weight, which is a risk factor for many non-communicable diseases, diabetes inclusive.

Deborah Nalwoga Stephen Watiti Nkurunungi Brian Samuel Gonahasa

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