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Starting treatment is 3tc/efavirenz/tonofovir a good bet?
Aug 29, 2003

I am asymtomatic HIV+ 33, positive for 2 years. My CD4/VL have been relatively stable although drifting down(for cd4). My last tests were dramatically different VL 700,000 (3months previously 50,000) CD4 203 (280). 18 (28). I am repeating the tests but have been advised to think about starting treatment. It appears that 3tc/efavirenz/tenofovir can be taken as a once daily combo which would suit my work but I am concerned that there has been a clinical study (I think with abacavir) with tenofovir that wasn't so good. Is this a viable option or should I aim for a twice daily regime? (And if so which is the current recommended initial therapy). Is it worth getting resistance testing done before I start ?

Response from Dr. Young

I would agree with the assessment that starting medications in the near future would be a good idea-- you have a decreasing CD4 count and high HIV viral load.

The treatment regimen of tenofovir (Viread)/ 3TC (lamivudine, Viread)/ efavirenz (Sustiva, Stocrin) should be a very well tolerated, simple to take initial drug regimen, assuming that your virus is a fully drug susceptible one. You've mentioned drug resistance testing, and I would encourage you to have this testing done, particularly if you live in the US or Western Europe, where as many as 1 in 8 (or more) newly infected persons have evidence of drug resistance.

The ongoing Gilead 903 clinical trial is evaluating exactly this regimen and has shown excellent potency and tolerability. Given your request for a once-daily treatment regimen, the TDF/3TC/EFV regimen that you mentioned is probably better than other potential once-daily treatments, especially given the fact that the two year data from this study continues to be very supportive. The twice daily options of AZT/3TC/EFV or d4T/3TC/EFV would also be worth considering and both have substantial long-term studies; but if once-daily is where you're at, I think that the tenofovir-based treatment should be fine.

You've mentioned a clinical study that used tenofovir with abacavir (not part of your proposed treatment)-- this was a study presented by Farthing at this years IAS meeting (see TheBody's conference coverage for details). The study looked at the triple nucleoside combo of tenofovir/3TC/abacavir and unfortunately showed very poor results-- suspected because of some yet unknown interaction between the three drugs.

Good health-- BY



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