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Second opinion on selecting starting regimin-treatment naive
Apr 30, 2003

Ready to start meds.... My CD4's have dropped to 310 with a VL of 66,700. My doctor and I feel it's time to start medication...so I need some help with deciding which combination. His first recommendation was a combination with AZT,Epivir & Susteva. I wanted to a once a day and wanted to avoid some of the side effects of AZT, so I've opted for Epivir, Viread & Sustiva, once a day at night with apparently no food restrictions per my doc.

Question 1: The Viread docs say to take with food, however my doctor says this is outdated and you don't have to take it with food. What do you think?

Question 2: Does this sound like a good combination with great long term suppression given my current viral load? I'm seriously committed to not missing any doses.

Quetion 3: I'm a frequent drinker and have heard this has a big impact on the immune system. How damaging is it to drink twice a week when living with HIV?

Summary: I'm 33, Tested HIV positive 6/2002, last negative test was 5/2001. Phenotype suggests possible resistence to Viramune, but nothing else. No symptoms yet, just some fatigue. I'm currently taking Allegra & Nasacort for allergies/chronic sinus drip, Paxil for depression & propecia to keep my hair from falling out. Also, lots of vitamin supplements.

Test numbers: 6/2002 - CD4 391, CD8 880, 23, VL 22,000 9/2002 - CD4 312, CD8 624, 26, VL 32,000 11/2002 - CD4 512, CD8 570, 35, VL 50,290 1/2003 - CD4 355, CD8 1,465, 24, VL 28,483 4/2003 CD4 310, CD8 1,032, 18, VL 67,700

Thank you very much for your support and feedback. I've spent hours on this site reading. You guys are amazing!

Response from Dr. Young

Thank you for your questions.

The combination of TDF/3TC/efavirenz has been studied in the recent Gilead 903 study-- I'd refer you to conference coverage at TheBody for details. The combination performed comparably to the excellent comparator arm of d4T/3TC/efavirenz and has decreased toxicity over the first two years of study. Indeed, the patients on the study with low CD4 counts or high viral loads did very well on the medication combination.

The dietary recommendations that your doctor has made are definately consistent with the current data about tenofovir. I've been recommending no specifics about diet to my patients, as most persons who took the medication in the largest trials did not take the medication with a fatty meal, as was suggested in earlier studies.

Alcohol in moderation should not have significant impact on the performance of the medications or on the immune system, per se. My biggest concern with any recreational ingestion, rather, is whether the ingestion(s) might result in problems with adherence. Short of this, a drink twice a week should not be problematic.

Good luck, BY



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