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Which Option
Nov 12, 2003

If given the following three options for intial therapy which would you choose or recommend, if any? Please help with this decision. Thanks for helping in advance.

1. LPV/RTV+EFV

2. LPV/RTV+2 NRTIS

3. EFV+2 NRTIS

Response from Dr. Wohl

The three options you list happen to be the three arms of a US AIDS Clinical Trials Group (ACTG) study (protocol A5142). The study will determine which of these is the best regimen as part of a strategy for initial HIV therapy.

At this point, the giants are efavirenz and lopinavir/ritonavir (Kaletra). Separately these two agents combined with 2 NRTIs have performed very well. They have not been compared head to head.

There are positives and negatives to each. Lipids increase with lopinavir/ritonavir but resistance to this drug is difficult develop. Efavirenz is generally well tolerated but does have important side effects and resistance to this agent is relatively easy to cultivate.

At the end of the day, which is better and will an NRTI-sparing regimen of these two titans alone be even better is a question that we shall have answered during the next year.

Right now, I use both options 2 and 3. I may tend to rely on Kaletra more for those with viral loads that are higher and CD4 counts that are lower. Often it is the ability of the patient to take pills, their pre-treatment lipids/diabetes status or their need/desire for a once a day regimen (efavirenz plus 2 NRTIs can be once daily) that sways me one way or the other.

I encourage anyone about to start HIV therapy, who lives in the US near an ACTG unit to consider joining this important study. The regimens, as stated above, are all potent and you may help determine what is the best all around initial HIV therapy.

DW



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