What’s been running through my head lately? Efavirenz. And I’m not exaggerating. This is my third week on Efavirenz, and it’s been trying to drive me crazy.
When the doctor changed my medication from Nevirapine to Efavirenz at the RITM two weeks ago, she had warned me about the side effects. Among these, were dizziness and dreams. I was thinking anything would be better than the fever and rashes I was experiencing with Nevirapine.
So I started on Efavirenz, just once a day, taking the doctor’s advice to take it in the evening, making sure I’d have nothing important to do after taking it. I never experienced any of the dreaming, but man, she wasn’t kidding about the dizziness.
I’ve been trying to come up with some way to accurately describe the feeling, and I’ve actually come up with a number of them.
First thing that came to mind, was that it felt like I was seeing the world through someone else’s prescription lenses. It was like being drunk, but not tipsy. My mind was all a blur.
It wasn’t exactly impairing me. Rather it was even making me move faster. More efficient maybe? I’ve noticed I’ve been able to go through my morning routine faster, making me arrive at work earlier. I even walk faster. I don’t know if it’s giving me more energy or something, but the world seemed to slow down relatively. Crazy, huh?
A friend of mine may have caught a good description, saying it must feel like being on a third straight cup of coffee. I couldn’t really tell, not being a coffee drinker, but maybe, it made some sense.
I also described it as feeling like everything I do, everything I hear, everything I think, everything I see, just echoes in my head twenty times before setting in. It felt chaotic.
So that’s how I’ve been feeling for the past two weeks. Admittedly, I seem to be getting the hang of it. At this point, it’s no longer as bad as the first few days. Things in my head are clearer now, and I feel I’m getting back to my old self again. U and C did say it’d be this way, and that I should be dizziness-free anywhere between a week and a month.
So all in all, I’m pretty happy about the Efavirenz. I haven’t been having to think about it much, and have even had to worry more about my Hepatitis B and Syphilis. Well, not really.
I’ve visited the doctors at Social Hygiene Clinic again to start another round of penicillin shots for my Syphilis. As for the Hepa, the lab tests show I’m an active carrier, and the result of the latest lab test for the Hepa Viral Load hasn’t come out yet. The doctor says it’s nothing to worry about, because one of my HIV medications, Lamivudine, is actually also a medication for Hepatitis B. So we’re actually hitting two birds with one stone here.
The fortunate thing is that I haven’t had any manifestations of either of what a doctor friend of mine regards as my HIV “add-ons”. I’ve always said, having HIV is one thing, but adding Hepatitis B and Syphilis isn’t anything to be proud of. Although, it’s still far from the end of the world.
So for now, they’re just a few things more to deal with, aside from work, family and love. Just another part of the macro scale of life. No biggie.
How about you? What’s been running through your head lately?
Monday, September 22, 2008
In My Head
Tuesday, September 16, 2008
Nevirapine
IUPAC name 11-cyclopropyl-4-methyl-5,11-dihydro-6H-dipyrido 1,4diazepin-6-one. Formula C15H14N4O. Nevirapine, also marketed under the trade name Viramune by Boehringer Ingelheim, is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection and AIDS.
As with other antiretroviral drugs, HIV rapidly develops resistance if nevirapine is used alone, so recommended therapy consists of combinations of three or more antiretrovirals.
Nevirapine in triple combination therapy has been shown to suppress viral load effectively when used as initial antiretroviral therapy. Some clinical trials have demonstrated comparable HIV suppression with nevirapine-based regimens to that achieved with protease inhibitors or efavirenz. Although concerns have been raised about nevirapine-based regimens in those starting therapy with high viral load or low CD4 count, some analyses suggest that nevirapine may be effective in these patients.
Nevirapine may also form a useful component of salvage regimens after virological failure, usually in combination with one or more PIs as well as nRTIs, especially in those who have not previously taken an NNRTI.
The most common adverse effect of nevirapine is the development of mild or moderate rash, observed in 13% of patients. Severe or life-threatening skin reactions have been observed in 1.5% of patients, including Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity. Nevirapine may cause severe or life-threatening liver toxicity, usually emerging in the first six weeks of treatment. All prior information have been sourced from Wikipedia.
At the RITM, I was initially put on a once-a-day dosage of Nevirapine. I had surpassed the two week trial period, and had graduated onto a twice-a-day regimen, at which point I had started experiencing low-grade fevers in the first couple of days. On the fifth day, however, my fever went up into the 40s, and at that point I was instructed to stop taking it, and to report as soon as possible to the RITM. Apparently I had begun experiencing allergic reactions to the drug, which was later on replaced with Efavirenz. I was able to observe rashes as well, even around five days after stopping the Nevirapine. The rash has subsided since, not really being too noticeable to begin with. Dealing with Nevirapine is not impossible, as I had met at least one other person who was well into the treatment, and not experiencing any allergic reactions.
One thing I was looking forward to with Nevirapine, is that people who were on it are said to tend to gain weight, a huge fantasy for a hard gainer as myself. Too bad it didn't work out.
Tuesday, September 09, 2008
Oh Efa, My Efa
Efavirenz. We’d actually met long before it became part of my own regimen.
The first time U and I met, we watched a movie together. The movie time just happened to encompass the time he was supposed to take his medicines. He had accidentally dropped his Efavirenz inside the theater, and he couldn’t figure out where it went. We waited for the end of the movie when all the other people in our row had stood and left. With our cellphones as lights, we started searching under the seats for his tablet. I asked him what it looked like, having no idea. He said it was a small, yellow tablet. I picked up something small and yellow. Good thing I didn’t shout that I’d found it, because I realized all I had in my hand was an unpopped kernel of corn which just may have come from heaven knows whose mouth. Recalling that incident still makes me giggle, with a bit of embarrassment as well.
So how was my first night through Efavirenz? I can’t really say. It’s a pretty cloudy picture. Here’s the deal, I took my first tablet last night at 9:30, along with the Lamivudine+Zidovudine. I was lights out by 10:00 pm. I left a small night light on in the room, just in case I wake up suddenly wondering where I am.
All I can recall is a whole lot of tossing and turning. I even remember telling myself I’d have to kill someone for keeping me up that late. The last time I checked the time it was past 1:00 am. At some point, I was lying in a plate of food, trying to split it into four portions... with my body. And of all things, it was adobo... chicken adobo. I do not have any particular addiction to chicken adobo. I found it a bit weird that I could recall it that vividly.
I’m not sure for which parts of the night I was actually awake or not, but I never ever recalled losing sight of my night light. So it’s either I had carried it over into my dream, or I hadn’t slept a wink. I honestly cannot figure it out. If only based on the headache I have right now and the bags under my eyes, I don’t think I slept a minute. Everything is just so fuzzy.
Hopefully, with the wear of still recovering from the Nevirapine, plus the possibility of two whole days without rest behind me by tonight, I’ll surely be seeing the sandman.
Monday, September 08, 2008
Dream, Dream, Dream
I haven’t really been able to blog lately, not by any choice of my own, I was just literally physically unable to blog.
I had taken the trip out to the RITM mid-week last week. Half of my purpose was to introduce my new friend to the RITM, as he’d be starting his own journey very soon. The other half of my purpose was to update them on how I was doing with my meds.
I had started my double dose September 2nd, and was experiencing low-grade fevers the two days following. Sadly we didn’t catch the doctor, since she had a personal emergency she had needed to take care of. Instead Ate contacted her via mobile, and it was agreed that I’d try to continue the medication, and if anything else comes up or gets worse, I’d just inform them and they’d decide whether I was to stop or not.
And indeed, worse was it. Friday caught me down with the weather at work, where I was struggling to get through even the final few hours at work. I had a fever, which felt worse than my usual. I didn’t have my thermometer with me, so I had no way of telling. I had even gone up to the lobby of an upper floor to rest my eyes. I was feeling that bad.
Getting home, I locked myself in my room, and my trusty thermometer read a 39-degree fever. Still I wouldn’t give up and continued taking my medicines that evening.
Saturday morning came, and I still had the fever, this time it was up to 40 degrees. I realized that my thermometer could only read up to 42 degrees, so I was pretty alarmed. I didn’t even mind that it was just 7 in the morning, I sent a text message to Ate, to which she immediately replied for me to stop the Nevirapine and report to the RITM come Monday.
You’d think my problems were over, but the fever was hell. I felt half-dead and half-dying. Having no airconditioning, no fan, layered with a sweater and a blanket did nothing. The chills were coming from deep inside. I felt I needed to swallow a blanket or kill whatever vents were inside me. I just felt helpless.
I was locked in my room most of the weekend, tossing and turning in discomfort, sneaking in an occasional cold shower to disperse the fever I was experiencing. Monday, I called in to work sick, and just headed to the RITM in the afternoon. I still had a significant fever, and my body just felt so heavy. Each step felt ten times more of an effort to make. I figure I must’ve been walking like I had a hangover.
The verdict? The doctor concluded I was showing allergic reactions to the Nevirapine. Though I didn’t really see signs of being counted as the 103rd Dalmatian, the doctor did notice I was reddish around the face, something which I do not normally get, as I can only be dark or darker. I was just lucky enough I guess that it was an even color, something less noticeable that the kinds of rashes I’ve seen.
I ended up surrendering what Nevirapine I had left, which was one unopened bottle and about half of another, trading it in for my new best friend, Efavirenz. Yes, yes, the dreaming drug. One huge difference is that it’s only taken once a day. Some things I was told to watch out for are dizziness and the dreams, of course. Some people describe the dreams as very realistic, in full-color, plus they say the dreams are usually resumed in cases where you wake up in the middle of one. The doctor also warned me that in standard drug tests, Efavirenz causes false positives for Marijuana, which is never a good thing. So if ever the need arises, it should be advised to the laboratory prior, so they can proceed to a confirmatory test, for which it should turn out negative. Good thing I’m not due to get my license renewed for another three years.
As I’m writing this, I’m feeling a bit better. Less of a headache, and lower fever. I’m hoping this is a good sign, so I can report back to work tomorrow. For now, I’m almost due for my first dose of my new regimen. And boy, am I ready to dream!
Wednesday, September 03, 2008
Low, Low, Low
I haven’t really been feeling well today. Yesterday was my first day on the full dose of ARVs, and I woke up this morning with a low-grade fever. Using my dad’s old thermometer, I took a reading of around 37.7 degrees Celsius at 5:30 in the morning.
Getting a fever doesn’t usually get me down, but it being one of the Tres Marias I was told to watch out for – rashes, fever and flu – I needed to consider if I had to do something about it.
I’m still hoping the fever was just a fluke. The extreme changes in weather here, from wet and cold in the evening and hot and humid in the daytime, may just have gotten to me. Plus my mom is nursing a flu, and one of my bosses is, too, and still reporting to work. Those just might be some factors.
So with that, I decided I’d take it. The doctor specifically told me not to experiment with Paracetamols should a fever happen, so I didn’t. I was feeling a bit better on the way to work, having been able to work up a sweat on the morning walk to and from the bus routes.
Just before my 9:30 schedule this morning, I got tasked to play messenger, to take a trip to Makati to personally deliver a check to an important contractor. This wasn’t the best day, but I did it.
I drank my meds and headed off in the heat of the Manila horizon. I was there and back in under two hours. We ate lunch here at the office, and here I am. Feeling better. No fever, no rashes, no flu, but terribly sleepy.
Good thing I have a trip to the RITM scheduled tomorrow afternoon. Primarily, I’ll be accompanying a new friend of mine to introduce him to the places and the people and get him started on his "journey". I’ll be able to consult my personal concerns with the doctor as well, regarding the lab results, the fever and the ARVs.
Tomorrow will be another long day.
Sunday, August 24, 2008
Day 6
I’m now on day 6 of my anti-retroviral treatment, and I have no big news to tell you. And that’s a good thing. I’ve been on Lamivudine+Zidovudine twice a day, and Nevirapine once a day.
I was wondering why I was given different meds from the other guy who was starting the same time I was. We had compared notes while at the RITM, and realized I got the Nevirapine which was notorious for rashes, while he got the Efaverenz which was known for dreams, nightmares and hallucinations. I was thinking to myself, “I want to dream, too!”, but just left it all up to fate.
It’s the Nevirapine that I was told to be wary of, because of some possible side effects. But so far, on a once a day dosage, nothing. No gagging, no vomiting, no diarrhea, no fever, no flu, no rashes.
One thing I noticed, is that I get hungry more easily since I started on the meds. It was so bad that I couldn’t wait to get home for dinner Friday night. I had to pass by the local Julie’s Bakery and get me a couple of pieces of bread which I chowed down on walking home. So might this make me put on weight? I hope so. This might just be the answer to my long standing problem of being a hardgainer.
At the RITM last Tuesday, the doctor asked me what time would be most convenient for me to take the meds. Once in the morning, once in the evening at a 12-hour interval. Initially I chose 6:30 am and 6:30 pm, imagining I’d take the meds after breakfast in the morning, and before leaving work in the evening. I eventually changed my mind, and decided on a 9:30 habit. So what happens is I take my meds in the morning while at work, and in the evening, just before going to bed.
The 9:30 habit was a good choice, as I noticed I didn’t feel anything unusual even while at work. Saturday night, though, I realized another side effect that Nevirapine may be having on me.
C, U, and I (Yes… surprise, surprise… C & U knew each other and didn’t tell me until recently… talk about connivance…) met up for some late snacks at the local mall yesterday evening, so for the first time since getting on ARVs, I was up past my usual bedtime of 10:00 pm. I just felt soooo sleepy after taking my medications, but not to the point of dizziness, as I was able to make my way home without problems. So in a couple of days, once I start taking the regular dose of Nevirapine, which is twice a day, I’ll have to figure out how to handle the drowsiness while at work.
U especially had been checking up on me regularly, having experienced the side effects of Nevirapine himself. He and C were both on Efaverenz themselves.
So for now, everything is good. I’m still able to work, still able to do chores, and still able to eat anything I want. Still no one can tell just by looking at me that I have HIV, nor that I’m on ARV medication. I still remain most wary about any signs of rashes. I constantly check my inner arms and forearms, where I am most fair and think that early signs of rashes will be most noticeable.
Watch out for my next big step.
Wednesday, August 20, 2008
A Normal Day?
It's been raining most of the day, and classes have been suspended around Manila. It's almost the end of the day, but we still haven't been let off from work.
Work? Yes! I am working today. It's my first day on ARVs and yes, I am still able to work, which is always a good thing.
I slept through my first set last night. No dreams, no nightmares. No fever, no rashes. Woke up my usual time, went through my usual routine, except of course for my new 9:30 habit.
So here I am, almost at the end of another work day. Been checking my arms regularly for signs of rashes, so far, so good. Looks like I'm surviving. I'm still keeping my fingers crossed.
