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which combo
Nov 15, 2003

Hi, My doctor wants to start me on meds now. I've been positive for over 12 years now and never been on drugs. My last labs were tcells 315 19 and my viral load was 4,500. He gave me a few choices and I was wondering which one you think is the best??

Sustiva/Epivir/Viread Sustiva/Combivir Viramune/Epivir/Viread Viramune/Combivir or the new drug Emtriva in place of Epivir? Thanks so much, Tony

Response from Dr. Wohl

Dear Tony,

Chances are any one of the eight combos your doctor has so kindly placed in your lap would work just fine. Your viral load is low to begin with and these are all potent regimens. The differences are in their dosing and potential adverse effects.

If you feel a once a day regimen would better suit your lifestyle and temperment, then you will be a Sustiva man. While nevirpaine (Viramune) can be given once a day, it is associated with more liver toxicity. Combivir is twice a day. So that leaves an efavirenz (Sustiva)+tenofovir+Epivir/Emtriva combo. Emtriva (FTC) is like Epivir (3TC) but lasts longer in the blood and cells. This is probably of some advantage. Additionally, tenofovir and FTC will one day in the not so distant future come in a single pill.

However, if twice a day is just fine with you then it comes down to side effects. Sustiva can cause some sleep and dream diisturbance and other cognitive problems but this is short lived in the great majority - resolving within about 4 weeks of starting the drug.

Whether Combvir (AZT+3TC) or tenofovir+3TC/FTC is best is not clear. A head to head between Combivir and tenofovir+FTC both combined with Sustiva is ongoing. I suspect there will not be a great difference between these in potency.

So, look at how you would like to take medications every day for the next few years, the side effects AND their likelihood. You can also put your doc in the hot seat and ask if he/she were you with your CD4 and viral load, what would they pick. You may not go with the answer but at least let them squirm with the choice they gave you.

DW



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