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Treatment for the first time
Jun 8, 2004

Hello Dr and thank you so much for taking my question. I would like to know what assesment or data/input you could share about starting treatment for the first time as a newly diagnosed (Dec 2003) on: Lexiva+Epivir+Ziagen. Any issues, red flags, detrimental long time effects? Don't have resistance to any drug based on blood analysis. So far doing fine. Eating healthy as much as I can and working out 4 times a week. Thank you so much for your time and God bless everyone here!

Response from Dr. Pierone

Lexiva is one of the newest of the HIV medications. It is a protease inhibitor that has a better side effect profile that some of the first generation PIs. It can be used with or without Norvir to boost its blood levels. If combined with Norvir it can be dosed once daily (2 Norvir, 2 Lexiva). If not used with Norvir, it is 2 Lexiva pills twice daily. As a protease inhibitor it has a tendency to cause GI upset and raise levels of cholesterol and triglycerides, but typically not to a major degree.

Epivir and Ziagen are soon to be approved for combination use together in one pill that can be taken once daily. Epivir is great, very few side effects. Ziagen is a bit more challenging to use; it causes a drug hypersensitivity syndrome in about 5-7% of people that take it and must be monitored closely during the first few months.

For fair balance, here is a question to answer. Why not start with a regimen like Epivir, Ziagen, and Sustiva? This would be 3 pills once daily instead of 6 pills once or twice daily. This highlights the NNRTI vs PI debate regarding initial therapy of HIV infection. In the U.S., NNRTI-based therapy is more often used first because of long-term data showing that it tends to work as well (or better) than PI-based therapy and has fewer side effects.

But (and this is a big but) people that have spotty adherence (miss doses, take some pills, not others, etc) they can quickly develop resistance to NNRTIs (like Sustiva and Viramune) and because of cross-resistance, lose the entire NNRTI class. PIs like Lexiva when boosted with Norvir, are more resilient with regard to development of resistance and may do a better job for people that have challenges with adherence.

There is a large study underway comparing Kaletra (fairly similar to Norvir boosted Lexiva) versus Sustiva in treatment nave patients and perhaps this study will help us make better recommendations for people starting therapy. Best of luck to you and keep us posted.



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