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Starting on viread, epivir and sustiva
Jan 13, 2003

I have been HIV+ for 3 years. Before HIV I was a healthy active person who worked out regularly and ate a decent diet. Ove the past year I developed shingles, thrush and a month-long cold. My viral load skyrocketed to 750,000 and my t-cells dropped to 341. So on Dec 14 I started on a combination of viread, epivir and sustiva, which my doctor believes, based on studies, will provide the best chance to bring my viral load down, and allow for good adherence and fewer side effects. I take them each once a day, the viread and epivir at 8pm and the sustiva at 10pm. I had an upset and crampy stomach for about a week with the viread and epivir, and the sustiva made me "loopy" for a couple of weeks, but I find that lessens over time. Food with sustiva does make me loopy very quickly! I have a few questions:

-Is there anything I should know or any advice you'd offer to me regarding this combination? Is my schedule a good one?

-Regarding adherence, I'm not clear what that totally means. Do I have a window of time on either side of my time frame in which to take the meds, and if so how much?

-The viread is supposed to be taken with a meal, although I have eaten at 7:30 on some days and then taken the pill at 8pm without additional food (although I still feel full). Does this matter, or should I always eat a meal with it? Should I switch my time to 7:30?

Thanks for your advice. I'm feeling a bit overwhelmed and a lot naive!

Response from Dr. Wohl


I agree with your doctor. This is a very good option for initial HIV therapy. The combination of tenofovir, 3TC and efavirenz can really be taken as a true once a day regimen. Although the package insert of tenofovir says it should be taken with some food, more recent data indicates that is not probably required. (The company that makes tenofovir is trying to have the package insert changed based on these data.) Therefore, you could take all three on a relatively empty stomach before bed.

As far as adherence goes, you should try to take your medications everyday without fail. You probably have a bit of wiggle room around each dose but I would try not to push it beyond an hour or so (i.e. take each dose 22-26 hours apart). DW

Should I Start now wait
Very Low TC4 count

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