Hello, a friend of mine with a VL of about 400,000 and about 200 CD4s was suggested the following first line treatment: Tenofovir, Emtricitabin, Ritonavir and Fosamprenavir. I wonder whether this makes sense since the gold standard is Combivir+Kaletra or Sustiva (I am doing extremely well in Combivir+Kaletra)in treatment naive patients. He has not strated treatment yet and we are exploring all options. Thanks for your help! **James**

James, thanks for your post.

First off, you are correct in the statement that Combivir + Kaletra or Combivir + efavirenz are among the preferred regimens in contemporary guidelines. There is a lot of very long-term data with either of these two regimens.

That said, there is a growing sentiment to use alternative NRTIs (like the tenofovir+emtricitabine fixed dose combo called Truvada or abacavir+3TC, called Epzicom or Kivexa)instead of Combivir-- this is primarily to acheive once-daily dosing of the medication, but also to reduce the initial risk of AZT side effects or toxicity.

In our clinic, we have an ever growin number of patients electing to start first line therapy on boosted PIs instead of NNRTIs-- this is generally because the newest PIs, atazanavir (Reyataz) and fosamprenavir (Lexiva, Telzir) are much easier to take (fewer pills, less side effects and no diet restriction for fosamprenavir) yet still have the potency and favorable resistance profile that Kaletra offers.

So, I think that the regimen that your friend's doctor has proposed is not unreasonable, though still relatively under studied (I've prescribed it myself on a number of occassions). There are several clinical studies that are ongoing with the combination of tenofovir/FTC + fosamprenavir/ritonavir and a large body of evidence with abacavir/3TC + fosamprenavir/ritonavir. The later data set should give some details as to what kind of results to expect, and anectodaly speaking, our results have been very good with both.

Thanks for reading. Let us know how this turns our for your friend. BY