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Which Option
Nov 25, 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. Pierone

1 is Kaletra/Sustiva 2 is Kaletra and 2 nukes (Viread, Epivir, Retrovir, Emtriva, Videx, etc) 3 is Sustiva and 2 nukes

I would favor either number 2 or 3 (although option 1 certainly works). Choice of initial therapy depends on the needs and characteristics of the individual person being treated. Option 3 is the most popular initial choice because it is easier to take and has an excellent track record. However, for people with adherence challenges there is potential for early virologic failure because resistance to efavirenz (Sustiva) just takes one viral mutation. Resistance to Kaletra requires multiple mutations for resistance and this is the attribute (along with its potency) that influences many physicians to use it up front despite the greater pill burden and metabolic problems.



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