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New HIV trial treatments ???
Dec 30, 2008

Hi Dr Moyle, great to have you back, l hope your xmas break was good...

my last test was cd4 375 and virol load 83,000........ l am getting ready to start meds, and live in Australia, my doctor said l can go into a trial program, as a first up option, but l would rather start on tryed and proven meds....

Dr could you please givem a list of once daily meds with the least side effects,that l can suggest to my doctor...

also l am 39 years of age, with no heps and healthy... if l was say going to live to 80 before catching hiv, how many years would it take off my life and also quility of life ??? my doctor has done a test and said kivexa and nevirapine 3 tabs in the morning is what he will recomend for me.... what do you think about this mix ???

thank you so much for your time

Kenny

Response from Dr. Moyle

Nice to be back There are lots of good treatment options with simple, low pill burden once daily dosing. The combination your doctor suggests is one example albeit not a widely tested regimen (mainly because of an overlap in side effects between abacavir (in Kivexa) and Nevirapine. Most international guidelines recommend Truvada (tenofovir/emtricitabine) ahead of Kivexa due to a greater wealth of data and some concerns about efficacy of Kivexa in high viral loads (>100K) and cardiovascular safety concerns. Neither issue particularly applies to you at present. Amongst NNRTIs Efavirenz is generally preferred to Nevirapine due to a greater wealth of data and a perception that its side effects, while more common, are less potentially serious than the rare nevirapine side effects on skin and liver. Efavirenz sleep and dream disturbances, typically over the first 2-3 weeks are not to everyones liking. 4 diffrent companies have althernatives to efavirenz and nevirapine in development, joining a trial may help us all realise the goal of a better tolerated NNRTI sooner. Please consider this a good option. The alternative to NNRTIs at present is a once daily PI, the most compact and well studied is Atazanavir, which with Truvada and ritonavir would be 3 pills with breakfast. Its is a well tolerated combination although the occasional persons with a genetic vriant called Gilbert's syndrome with get reversible slight yellowing of the eyes. I hope this helps with making a rather important decision Best of Luck Kind Regards Dr Moyle



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