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HAART and Hep C
Jul 31, 2001

I am HIV/HCV infeced. I have been off anti-retroviral therapy for HIV due to liver toxicity for almost 2 years. My liver is much healthier as a result however my immune system has taken a dive and it's time to begin antiretroviral therapy again. My virus has reverted to wild type so my treatment options are open although I did at one time show resistance to NNRTI's. I understand the "d" drugs are the most toxic to the liver, is this so? I am still very concerned about the toxic effects of these drugs on my liver. Which combination therapy for HIV would you recommend as the least toxic?

Response from Dr. Dieterich

If you once showed resistance to NNRTI's then you will again quickly. In general the least liver toxic nucleosides are 3TC Abacavir and AZT. The d drugs can be problematic, although that does not mean they can't be used. Of the protease inhibitors, nelflinavir, saquinavir and amprenavir are the least likely to cause hepatitis, and ritonavir Kaletra and indinavir, the most. However once again if you have to take one, you can but just be careful. If you do run into toxicity issues again, you can always treat the hepatitis C! Then after 2 or 3 months you can add on the HIV meds and will get much less toxicity. Good luck! DTD



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