In your original post, you said:
"For antiretorvirals, I am taking the following: Combivir as AZT & 3TC (YES, I know AZT is poison, but it works for me.) Sustiva, and Viread. I take Effoxor ex for depression and will be soon changing it to Mirtazapine. Prochorperazine for nausea, Trazdone for sleep, and Avandia for appitiate. "
Sorry to keep posting but I am still pondering why you are on this combination? I feel like whatever physician(s) that put you on this combination really missed the boat on several very serious issues and has gotten caught in the "medical rut" of just treating and chasing symptoms rather than looking at the whole of the situation--especially "quality of life" issues and cause and effect, not to mention the potentially life threatening depression which is a listed side effect of Sustiva. And this is actually a very easy problem to get caught up into over time as most physcians are very overworked in this field and do not have a lot of time to consider your individual situation. So it is really up to you to point out what is going well and what is wrong. You have to learn to work WITH your HIV practitioner. It seems to me that you are overdue for a complete re-evaluation of all of your clincal symptoms, overall health, anti-HIV therapy, hormonal replacement therapy, anti-wasting therapy, body compostion analysis, etc.
Did your doctor ever consider taking you off of combivir and putting you on two times per day epivir @ 150 mg/tab PLUS Viread PLUS an NNRTI other than Sustiva?
Sorry to tell you this but AZT is NOTORIOUS for gastrointestinal problems and causing loss of appetite--considerable more so than any other NRTI. Aside from the fact that it is also quite suppressive of bone marrow (which is why you should probably be on 200 mg/week of Deca while on AZT). It is also THE MOST likely source of your nausea and lack of appetite out of everything you are taking BY FAR and if it is causing any significant degree of bone marrow suppression in you, it will also cause a significant degree of general fatigue or lack of energy as well.
Also since Viread, Epivir and AZT are all essentially in the same class of drug (viread being very slightly different) and therefore the mode of action is similar, it can also be expected that similar side effects are most probably additive as the mechanisms for causing them are most likely also similar (I am treating this from a basic toxicological aspect). The AZT is the MOST TOXIC of those three drugs but does not necessarily suppress the virus to any greater degree than the others so my STRONG gut reaction is that AZT is the one I would remove from the combination considering this from a viewpoint of benefits to side effects. Dropping the AZT MIGHT allow you to drop taking the anti-nausea medication and the appetite stimulant medication after enough time has elapsed for the AZT to clear out of your system and your system reaclimates.
The other change I can not stress considering strongly enough is substituting the Sustiva with a different NNRTI. This would certainly allow you to sleep better and may actually allow you to drop the Trazadone and eventually ween off of anti-depressants over time as well. My gut reaction is that you are overmedicated to be honest. I think changing your basic anti-retroviral therapy may help you make these deletions. Often, less is better. Remember, the more prescription medications you are on, the more likely it becomes to have cross drug interactions and increased side effects across the board. The chances of "nonlisted" side effects also increases due to combinations of interacting drugs as this is something that is virtually impossible to anticipate during the studies performed to determine side effects and safety when first seeking FDA approval of the medication. One other thing to remember is that the depression caused by Sustiva often becomes life threatening. It is not uncommon for people on Sustiva to have suicide ideation and this is not to be taken lightly. Remind your doctor that Sustiva is CONTRA-INDICATED for people showing signs of depression.
You should also consider that by being on three NRTIs and one NNRTI, I still don't see how you are accomplishing anything more than a three drug combo of two NRTIs and one NNRTI such as a combination of Epivir, Viread and a different NNRTI than Sustiva, preferably Viramune which has been shown to be equally potent and durable as Sustiva. Delavirdine would be my second choice. But then again, I don't know what your viral load or T-cells are, your drug history, or what your CBC or Chems look like and I don't have any resistance pattern information about you either. So just more stuff to discuss with your physician.
Since you are going to your physician tomorrow, you need to discuss getting the basic stuff that he can help you with in order of priorities. That means that you need to focus on getting your basic HIV anti-retroviral medications straightened out first so that you can move to cut out all unnecessary prescription medications as your system readjusts. Then you also need to getting testing done as suggested in my previous posts to help straighten out your hormonal situation and check your lipid situation and work with your physician to establish appropriate hormone replacement therapy for you. Then you need to get some body compostion testing done (Bio-Impedence Analysis) so you can establish a baseline for evaluating the efficacy of your anti-wasting therapy/medications which you should absolutely be on with HIV disease.
One of the many problems with most HIV physicians is that many are adamant about NOT changing your anti-retroviral therapy if it is working to control your viral load and your T-Cells appear to be "ok." This is very myopic and does not consider the whole of the situation or quality of life. It also very badly underestimates such things as the very real danger posed by depression induced by Sustiva in particular. If your physician is of this mindset, I would strongly suggest you find another HIV practioner--one that will work WITH you as well as one that is extremely knowledgeable. Just a word of advice.
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