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Best starting regimen

Nov 28, 2003

Doctor Young,

Assuming no drug resistance, what regimen would you recommend for a treatment naive patient who has a low viral load, tendency to bad nausea (no AZT?) and diarrhea, a low normal HgB and RBC count and who is very viremic - sore throat, tender glands in throat and groin, nauseous, periodic numbness in toes, feet and face, weak legs (feels like the virus is in my central nervous system). I have very low normal creatinin and BUN levels.

Thanks - though my CD4 count is 700 and my VL fluctuates between undetectable on Roche 1.5 and bDNA to just above the test threshold, the symptoms are causing me to want to try HAART to improve my quality of life. I just don't want to have side effects that are as bad or worse than the symptoms.

Many thanks.

Response from Dr. Young

My first line recommendations for initial HAART therapy (for those who have fully drug susceptible virus) are in keeping with those recently published by the US Department of Health and Human Services-- namely efavirenz (Sustiva, Stocrin)with two nucleosides-- either Combivir (AZT/3TC) or tenofovir/3TC.

The wealth of scientific data exists for the Combivir/efavirenz combination and is generally my first choice. For those who must have a once-daily regimen or the few that don't tolerate Combivir well, then the combination of tenofovir/3TC is used.

Both (as well as other regimens) are typically very well tolerated. Recent advances in protease inhibitors also should be considered, particularly for persons who have very high viral loads (not you), or where adhrence might be less than optimal. Both atazanavir and fosamprenavir offer well tolerated, very low pill count options (that rival the original efavirenz) and have important attributes in the resistance arena. BY

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