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Nevirapine Combivir vs. PI combo
Mar 16, 2002

I am in Thailand, and getting ready to start treatments. CD4<350 VL35,000. I must pay for meds myself. My doctor wants me to start on combo of Indinavir/Ritonavir & DDI/D4T. This will cost me 450 a month (Ouch!).

Thailand is about to start manufacturing their own Combivir & Viramune. If I used this, the cost would be about 56 a month. Obviously that is a BIG difference.

How would you compare the effectivness of these two combinations? Do you think the Combivir/Viramune would work as well as the PIs? Thank you so very much.

Response from Dr. Young

Thank you for your question. Sorry for the delay in response.

The choice of first regimen is tricky, since there are many parameters that I use to pick the right one for any one person.

Overall, I think that the ability to have a simple, easy to adhere to regimen is very important. In this regard, ritonavir/indinavir has issues related to tolerance and side effect profile as well as elevations in lipids; nevirapine is generally very well tolerated, though in our practice, we don't use it in persons with active hepatitis. To my knowledge, no comparative clinical trials have compared these two regimens; in our hands, we have had success with both treatments. Some have argued that the simplicity of the nevirapine regimen works in its favor; though others have suggested (without comparative studies) that nevirapine might not be as potent as other NNRTIs, such as efavirenz.

So where does that leave us? Given the difference in cost, and that we are likely talking about a long period of treatment; seems to me that the later regimen makes sense. It it very, very important (particularly in NNRTI-based treatments) to be as adherent as possible; you'd certainly not want to "waste" the drugs with early drug resistance.

Good luck and let us know how things turn out; it's good to know that our site reaches persons in Asia. BY

non progressor
CD4 up CD4 down and the flu?

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