Dr Moyle l was tested recently and came back hiv +, l know l got the virus in jan 08, but got tested in may, first test 21% and cd4 432 and got tested two weeks later viral load 13,900 and cd4 384 and %25, one month later cd4 471 and viral load 19,500 and %22, my doctor in sydney oz wants me to take kivexa and nevirapine, when its time, Graeme could you pleasr tell me your opinion, l am a one every two weeks binge drinker, and want the less toxic drug for my liver and also, l dont want any chance of HAIR LOSS or sunken cheeks side effects NO WAY, so please give me your opinion on what first drug to take, that is morning once a day 1-3 pill tabs...

thank you marco

Hi Marco We have lots of options for initial treatment, the decisions are influenced by the virus acquired (a resistance test as soon as you know about your infection may help identify this, a history of treatment for the person from who you acquired HIV may also help), coninfections (esp. Hep B and C), drug intercations (any other medications, the occasional drink is not a problem), your job (especially shift work) your genetics (some people have hypersensitivity (allergy) to abacavir and nevirapine) to name a few. So it is an individualised decision. The medications most widely recommended (Kivexa and Truvada and NRTI pairs) wont trigger fat loss or hair loss. There are some concerns about heart disease with kivexa (currently under investigation) and kidney or bone problems with Truvda. These issues appear rare for both drugs and concerns may currently be seen as fine tuning. The most widely recommended 'third' drug is efavirenz but this necessitates morning dosing. The other recomended choices are protease inhibitors. The only once daily one approved in OZ is atazanavir (300mg od with ritonavir 100mg od, so 2 pills total). This would be a good morning option and has ben shown to be as good as twice daily alternatives with some safety (gut and lipid) advantages. In general, nevirapine is once daily for 2 weeks then twice daily.If you are stable on it, once past the initial 6 week risk period for rashes and liver problems, you can change it to once daily. So lots to think about and thats just the short version! Read as much as you can so that you can keep your Doctor on you toes and also consider that at some places in OZ you can also get the chance to help build the next generation of HIV medicines by participating in trials which may suit you well. You have plenty of time to think about it and get ready Best Wishes Graeme Moyle