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effective first line treatment
Sep 3, 2003

Hi

What do you think of the regiman (first line) Kaletra, Viread and Emtreva? I have vl of 300K and tcells about 350. I appear to be a rapid progressor (neg test march 2002). I really don't want to start yet. I read on CDC guidlines Kaletra may cause fat distrubution problems. Also, after readong the July 2003 CDC report, it is not clear to me that treatment is recommended if tcells below 350 OR vl above 50K. The report is much less certain, no?

Response from Dr. Pierone

Hello, if you really don't want to start yet, you should definitely not start yet. Although your viral load is high, your CD4 cells are not in a dangerous range yet and you have time to gird your loins for eventual treatment. The closer someone's CD4 count gets to 200, the more nervous I get about watchful waiting. Below 200 CD4 cells, watchful waiting is not appropriate and medications should be started.

I think the first-line regimen of Kaletra, Viread (tenofovir) and Emtriva (FTC) is a good choice. My personal tendency is to use a non-nucleoside (nevirapine Viramune or efavirenz Sustiva) in first line regimens instead of Kaletra. Mainly because there are fewer pills, once daily option, and lower risk of metabolic complications (fat changes, lipid increases) with these regimens. I think Kaletra is a great medication, extremely potent, but tend to save it for later regimens in case of virologic failure.



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