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Aug 22, 2004

Dear Dr,

when doctors mention that the first line ,second line ,thrid-line treament what does that exactly mean how is that work (i mean usually with how many medications , how many line treatment do we have in total )

i have PPD + (not active TB) what should i do? Does the medicin for TB will interact with sustiva and others medications i am very scare about this result(i have PPD + skin test) . if i have a good control of my VL and CD4 >500 shuld i worry about TB infactin will occur !

Thank you very much !

Response from Dr. Holodniy

The first, second, etc, treatment regimen usually contains at least 3 drugs, usually from at least 2 of 4 classes of HIV medications. After about 3 regimens it gets difficult to find new drugs that will have full activity and not have cross resistance with drugs. If you are taking INH (isoniazid) for the + PPD, that usually does not have as many drug interactions with HIV meds as if you were taking 3-4 medications to treat active tuberculosis. It might have more of an effect if you have chronic hepatitis with HCV or HBV or with heavy alcohol consumption, since most of the HIV drugs and INH are metabolized by the liver and if too many of these drugs are given, can make liver disease worse.

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