Nov 24, 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
Whether you 'need' to start therapy right now is debatable. Your CD4 cell count is below the magical 350 mark but your viral load is pretty darn low. The odds are that your CD4 will decline very slowly without therapy. I might think about seeing what the trend in your counts are, if you do not know this already. For instance if you lose about 50 CD4 cells or less per year you can consider waiting a bit before starting. However, if the drop has been more rapid and/or if you are feeling more aggresive initiating treatment now is justified.
Studies have shown that 3TC+Sustiva+most anything does very well. What to add to 3TC+Sustiva depends on a number of factors and preferences including your desire to be on a once a day regimen. Viread+3TC+Sustiva is taken all at once. Combivir is twice a day. A new combo of abacavir and 3TC administered once daily is coming out and would be another simplified regimen. Otherwise, I suspect you would do fine with any of these.
The current US Public Health Service guidelines recommend Sustiva over Viramune. This reflects a concern regarding the potency of Viramune relative to Sustiva. A recent comparative study of Sustiva and Viramune did demonstrate a better showing for Viramune than many expected and this drug is certainly an option. I generally only prescribe Viramune twice a day.
Again, over all, all the combos you mention would probably work. DW
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