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Now very confused what's truth about HAART
Feb 25, 2001

Dear Doctors thank you for your incredible work on this site.I am very confused about drug combinations. My Dr states that you cannot be on 3 drugs in the same class eg AZT,3TC and Ziagen.He also wouldn't just prescribe me Viramune.He insisted that it had to be Sustiva 800mgs and Viramune,he states this prevents mutants occurring.My Hx is tested both HIV/AIDS in April 2000. Initial numbers CD4 234, VL 50008. Had a severe shingles outbreak May 2000 , next blood work June 2000 CD4 251 VL 26000. Started viracept ,3tc and ziagen. After sereve diarrhea switched to Viramune,Sustiva,3TC and Ziagen. Numbers Cd4 287 VL 220. After a month on new combo CD4189 VL less than 50. At that point i was extremely ill my Dr was going to stop all meds ,I refused as it turns out was Diagnosised with Advanced NHL which the Oncologist believes that I'd had at least 6-8 months prior to October. I completed Chemotherapy end of January this year,in remission and i see the Doctor for blood work results Wednesday the 14th. I also tested neg March 99. My question is this I am taking too many damn pills and the Sustiva really affects my sleep and the weirdest dreams. What do you think of trizavir and viramune twice a day. And is it true that you have to be on dual non-nukes to prevent resistence.I don't think my Doctor has a clue he totally misdiagnosed my Lymphoma and i almost died. What do you recommend, thank you.

Response from Dr. Cohen

Well, yes there are options for you. Although from what you've sent in I am unclear about exactly which options you would have open to you at this point.

First - your physician may not be aware that there are studies using three nucleosides - Azt, 3TC, and ziagen - all three from the same class, and the results at least in the first year look as good as many other triple combinations. There may be reasons why your physician would prefer to use other approaches - but it certainly is an option that some have used successfully.

Also, it is very experimental to use two "nonnukes", using both viramune and Sustiva. Using them together has only been studied in a few people - and while they have done well so far, we are still learning about this approach from larger studies underway. It appears that resistance to this class did not happen however - since your viral load was below 50 copies while on these. So these could be options still at this point.

But the way to prevent resistance from happening on any combination is to define a combo that you can tolerate and take, that gets your viral load below 50 copies. You don't have to take a dual nonnuke regimen to achieve this - there are many other ways to do this. Including many that use just one nonnuke. You could do a four drug regimen - the one you mention is an example of a compact four drug combo that should work well.

However, one thought to keep in mind. You mention having a viral load that was detectable while on at least one of your combos. And if so, you might some underlying resistance to at least one of the meds you were on - particularly a problem when using 3TC, since resistance can develop at lower viral loads. So the four drug combo you propose may be effective, but you should monitor carefully to be sure your viral load does get to below 50 - based on what you write, this still seems likely.

So yes, in sum, you could create a combination of Trizivir and Viramune. And it should work for you. Hope that helps.

CC



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