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1st time regimen

May 13, 2004

I am from a small town w/ limited HIV accessability, however do see a Dr. w/ some knowledge about HIV.

Have had HIV 6 years, no health problems, 375 T-cell, 115,000 Viral.

Dr. wants me to start meds w/ Epivir, Sustiva, & Zerit. A friend has cautioned me about this combo, especially the Zerit.

with the correct advice, I will share w/ my Dr. Any insight on the better combo would be greatly appreciated. I am trying to learn, but it is hard to choose w/ so much info.

ThanX for your time and excellant service to the communities in middle AmeriKa. James

Response from Dr. Young

Thanks for your post.

I'd agree with your friends that in 2004, stavudine (d4T, Zerit) would probably not be my first choice as a component of initial therapy. This is not to say that d4T hasn't been a very popular and generally well tolerated drug, but rather that recent revelations about d4T's side effect profile (increased risk of lipodystrophy, elevations in cholesterol and risk of neuropathy) and the advent of alternatives, such as abacavir (Ziagen) or most recently, tenofovir (Viread) relegate d4T to the alternative first line drug in my clinic (and many clinics across the US). The use of either of these meds with 3TC (Epivir) and efavirenz (Sustiva) would be very supportable.

There are a number of large, prospective clinical trials that have evaluated abacavir/3TC/efavirenz or tenofovir/3TC/efavirenz. All have shown excellent tolerability and potency and offer the once-daily option that d4T currently does not. Furthermore, soon, we'll see an abacavir/3TC and tenofovir/FTC (a cousin of 3TC) fixed dose combination tablet, offering the possibility of a two pill, once-daily option. I'd vote for one of these possibilities.

Thanks for reading, keeps us informed of how things turn out. BY

anti-HIV gene
Beginning in L.A.

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