Dear Sirs,

I e-mailed you about a month ago, I suppose you get a lot of questions. I'm scheduled to start treatment on 4/2000 and I would like your insight. I was diagnosed HIV (+) 10/99 and I have reason to believe I was infected within the last 3 years. My initial #'s: CD4=503, CD4%= 19, VL=46500. I have no symptoms other than swollen lymph nodes. On 1/2000 my #'s were CD4=540, CD4%=23, VL=46000. My doctor -an HIV specialist is recommending I start on med's. She suggests D4T/DDI+Viramune, but I am under the impression that since you only have one shot at NNRTI's Sustiva is a more effective option. I have a history of depression and that concerns me I have heard some horror stories about psych side effects from Sustiva. I'm planning to take 2 weeks off from work when I start on med's, my rationale is that I should start on Sustiva and if I absolutely cannot tolerate the side effects I can always switch to Viramune, provided I'm not failing the regimen (I'm Tx naive, of course). Is this a reasonable decision, on your opinion?????

The combination regimen that your physician has chosen -- ddI/d4t/nevirapine (Viramune)-is certainly one that is commonly used. It is difficult to definitely state that an efavirenz (Sustiva) containing regimen is more potent than a nevirapine containing regimen since there has never been a direct comparison trial. However, nevirapine containing regimens have been shown to be effective, most recently, even in patients with baseline viral loads >100,000 copies/mL. Efavirenz can cause central nervous side effects such as vivid dreams, disorientation, etc although these are usually very short-lived. There have been reports of an exacerbation of symptoms in patients who have a prior history of psychiatric conditions.

I would suggest that you discuss your reservations with your physician. She should be able to answer your questions and help you with your decision. In any case, she should be aware of what you are taking. Good luck!

KES