I am a 30 yo male who was diagnosed hiv+ about two months ago, have a cd4 count of 473, and a viral load of 38410. my resistance tests showed Im resistant to sustiva, and viramune. My doctor says I should consider starting meds and to read up on and choose an NRTI and a PI. What would be your suggestions for the the most appropriate first time medication combinations. I would like to find something with minimal bothersome side effects, and the most options for future medications. Ive read up on each class of medications, but in your medical experience which have you found to be easiest for beginners? I look forward to your reply. Thanks

Thanks for your post.

I'm not entirely in agreement with your doctor that you need to start medications in the near future; but in any event, getting the best information about what medications to start with is very reasonable.

In our clinic, we frequently use either of the DHHS-recommended nuke combos, namely Truvada or Epzicom. If you have issues with kidney disease (or risks), then Truvada's probably not the best choice. Similarly, if your genetic testing shows a high risk gene for abacavir allergic reaction (called HLA B5701), you definitely should not receive Epzicom.

As for PIs, we've largely stopped using Kaletra for first-line treatment because of better responses (and fewer clinical side effects) with Norvir-boosted alternatives, Lexiva and Reyataz. In our clinic (in contrast to national trends), we use more Lexiva than Reyataz, because our patients prefer not to have any diet restriction or risk of yellowing of the skin. If Norvir isn't well tolerated, then there are some options for alternative non-boosted regimens.

In your case, with transmitted NNRTI resistance, preserving future treatment options makes a lot of sense; using a boosted PI is reasonable in this regard, since patients failing first-line boosted PIs rarely have broad cross resistance.

I hope this helps,

BY