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"Best Treatment" and Questions to ask
Oct 6, 2003

My partner was infected two years ago. We are going to see two infectious disease doctors this month. His CD4 is 324 and Viral load 19800. How can we tell which is the best course of treatment since they will probably start him on meds with a CD4 count so low? Is there a best first treatment? Also, what questions should we be asking? FYI, I am negative.

Response from Dr. Wohl

There are many factors that influence which is the best regimen for treating HIV infection. You certainly want a therapy that can be integrated into your lifestyle, has a risk of adverse events that do not sound too scary or unacceptable to you (i.e. high cholesterol in a person with heart disease, facial fat wasting in a fashion model, diarrhea in a truck driver) AND that is supported by data indicating it is effective and well tolerated.

The data we have available today suggests that nothing beats a triple drug combo that includes the drugs efavirenz (Sustiva) plus 3TC (Epivir) plus almost anything else.

Choices for the third drug include AZT, tenofovir, ddI, d4T, and abacavir. Which of these you chose or are offered probably will not matter much as far as getting the viral load down. There are differences in pill number, frequency, food restrictions and side effects.

If Sustiva is not do-able for some reason, the protease inhibitor Kaletra is another alternative that is popular and supported by solid evidence. Some would add nevirapine (Virammune) a sister drug to Sustiva and often used as its understudy. Feel free to write back if you get mixed messages from your physicians. DW

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