After your doctor has confirmed that you are HIV-positive, you may have been told to start taking this combination of medications. Since it has three names (Efavirenz, Lamivudine, Tenofovir), it can seem a little confusing at first. But don't worry. This is a very effective combination of medications used to control HIV all over the world. So today, let's talk about this medication, how it works in the body, how to take it, and what to watch out for in a simple, easy-to-understand way.
What really happens with this combination of medications?
Simply put, this is a combination of three types of drugs. We call these "antiretroviral medications." What this pill does is stop the HIV virus in your body from spreading further, that is, it controls the virus from multiplying.
Think of the HIV virus as an enemy that attacks your body's defense system (immune system). This medicine reduces the power of that enemy and keeps it under control. This allows your immune system to work stronger again.
The most important thing: This medicine does not cure HIV completely. That is, it does not completely eliminate the virus from the body. But it does control the spread of the virus in the body very well, helping you to live a healthy, normal life for a long time.
Another thing to remember is that even when you take this medicine, the risk of transmitting HIV to another person is not completely eliminated. Therefore, it is very important to continue to follow safe sex practices. Also, this medicine does not protect against other sexually transmitted infections (STIs).
Things you need to tell your doctor before starting this medication
Before your doctor prescribes this medicine, he or she will need to know your complete health history. So if you have any of the conditions listed below, be sure to tell your doctor. Don't hide anything, as it is very important for your safety.
| Illness or other factors | Why is that important? |
|---|---|
| Bone problems (e.g., osteoporosis) | The ingredient in this medicine, Tenofovir, can sometimes affect bone density. |
| Heart disease | In some cases, the rhythm of the heartbeat can be affected. |
| A history of mental health problems (such as depression, anxiety) or substance abuse | The ingredient Efavirenz can affect mental health. It is important to be aware of this if you have had previous problems. |
| Pancreatitis | This medicine can rarely cause pancreatitis. The risk is higher if you have had it before. |
| Epilepsy or seizures (Seizures) | Because this medication can affect the nervous system, you should be aware of the possibility of seizures. |
| Allergies to other medicines, foods or substances | It is essential to inform us if you have any allergies to the ingredients of this medicine or anything else. |
| If you are trying to get pregnant or are pregnant | You should talk to your doctor about the safety of this medication during pregnancy. |
| If the baby is breastfed | This medicine can pass to the baby through breast milk, so discuss this with your doctor. |
What is the best way to take the medicine?
This is the most important part that you need to follow exactly. To get the most out of the medicine, you need to take it exactly as prescribed.
- Take with water: Swallow this tablet whole with a glass of water.
- Take on an empty stomach: This is very important. The medicine should be taken at least 30 minutes before a meal, or 2 hours after a meal. The medicine is absorbed better by the body when taken on an empty stomach.
- Take it before bed: Usually, taking this medication before bed means that any dizziness or drowsiness it may cause will occur while you are sleeping, so it won't interfere with your daytime activities.
- Do not skip doses for any reason: Take your medicine at the same time every day, exactly as your doctor has prescribed. Skipping doses can cause the HIV virus to become resistant to the medicine. This can make not only this medicine but other HIV medicines ineffective in your body. This is very dangerous.
- Don't stop until your doctor tells you to: No matter how well you feel, continue taking this treatment until your doctor tells you to stop.
What to do if you overdose ?
If you think you have taken more pills than you think, don't delay. Go to the Emergency Department (ETU) of your nearest hospital immediately. Or call the National Poisons Information Centre at the Colombo National Hospital for advice.
What to do if you miss a dose of medication?
We all forget things sometimes. Don't worry if you miss a dose.
- Take the missed dose as soon as you remember.
- However, if it is almost time for your next dose when you remember, skip the missed dose and just take the next dose at the scheduled time.
- Do not take double doses to make up for a missed dose.
Special things to watch out for when taking medication
You need to take a little extra care of your health while using this medicine.
- Regular medical checkups: Your doctor will often ask you to have blood tests. Get all of those tests done on time. They will help you see how the medicine is affecting your body, whether the virus is under control, and whether your organs like your liver and kidneys are working properly.
- Serious skin reactions: Some people may develop severe skin reactions a few weeks or months after starting this medicine. If you have a fever, body aches, red or purple spots on your skin, blisters, peeling skin, or swollen lymph nodes in your face, lips, neck, or armpits, see a doctor right away.
- Driving and operating machinery: This medicine may cause dizziness and difficulty concentrating in some people. Therefore, avoid driving or operating machinery until you know exactly how this medicine affects you.
- Alcohol use: Taking this medication with alcohol can increase side effects like dizziness and drowsiness. It's also not good for your liver.
- Hepatitis B: If you have HIV and Hepatitis B, stopping this medication suddenly can worsen your Hepatitis B symptoms. Therefore, be sure to talk to your doctor about stopping the medication.
- Pregnancy Prevention: If you are using birth control pills (containing estrogen and progestin), taking this medicine may reduce their effectiveness. Therefore, talk to your doctor about using another form of birth control, such as condoms, in addition to using them.
Side effects of the medicine
Like any medicine, this can cause side effects. But not everyone gets them. Some are serious, while others are normal. The most important thing is to be aware of these and seek medical advice immediately if you notice anything serious.
Serious side effects that should be reported to the doctor immediately
If you experience any of the symptoms below, see a doctor or go to a hospital without delay.
| Side effect | How you feel |
|---|---|
| Allergic Reactions | Skin rash, itching, swelling of the face, lips, tongue or throat, difficulty breathing. |
| Liver Injury | Pain in the upper right side of the stomach, loss of appetite, nausea, light-colored stools, dark yellow or brown urine, yellowing of the eyes or skin, and extreme fatigue. |
| Mental and behavioral changes | Severe anxiety, restlessness, confusion, hallucinations, anger, suicidal thoughts, depression. |
| Pancreatitis | Severe abdominal pain radiating to the back, pain that worsens when eating or touching the abdomen, fever, nausea, and vomiting. |
| Kidney Injury | Decreased urine output, swelling of the ankles, hands, or feet. |
| Lactic Acidosis (increase in lactic acid in the blood) | Muscle pain or stiffness, stomach pain, difficulty breathing, general discomfort and fatigue. |
| Nervous system problems | Numbness or pain in the limbs, muscle weakness, vision changes, difficulty speaking, difficulty walking, seizures. |
Side effects that are common but should be reported to the doctor if they persist
These usually subside within a few days, but if they persist or bother you a lot, talk to your doctor.
- Back pain
- Diarrhea
- Headache
- Nausea
- Stomach pain
- Insomnia or strange dreams
Other medicines that should not be used with this medicine and that may cause problems
This is a very important part. You should tell your doctor about all other medications you are taking (including vitamins and herbal remedies). Some medications can interact with this HIV medication and cause serious problems.
Medicines that should never be taken together:
- Any other medicine that contains the ingredients in this medicine (efavirenz, emtricitabine, lamivudine, tenofovir)
- Disopyramide
- Elbasvir; grazoprevir
- Rifapentine
- Voriconazole
Other medications that may cause problems (inform your doctor if you are taking these):
- Cholesterol-lowering medications (e.g., Atorvastatin, Simvastatin)
- Antibiotics (e.g. Clarithromycin, Rifampin)
- Antifungals (e.g. Ketoconazole, Itraconazole)
- Medicines for heart disease and high blood pressure (e.g. Diltiazem, Verapamil)
- Anticonvulsant medications (e.g. Carbamazepine, Phenytoin)
- Medications for mental illness (e.g. Bupropion, Sertraline)
- Pain relievers (NSAIDS) (e.g. Ibuprofen, Naproxen)
- Warfarin (a blood thinner)
- Medications for HIV or other viral infections
This list is not complete, so it's safest to tell your doctor about all the medications you take.
Take-Home Message
- This medicine controls the spread of the HIV virus in your body. It does not cure the disease, but it helps you live a healthy life.
- Take the medicine on an empty stomach , at the same time every day, as the doctor told you. Never skip a dose.
- Tell your doctor about any other illnesses you have and any other medications you are taking.
- If you experience any serious side effects, such as severe skin allergies, liver problems, or severe mental changes, seek medical advice immediately.
- If you feel alone or depressed while taking this medicine, talk to your doctor, a family member, or a trusted friend. You are not alone.
- With proper treatment, you can live successfully with HIV.
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