Aug 8, 2004
I am looking for some input regarding treatment options.
I am 44 y/o, living a healthy and active lifestyle. I have been under physician supervision since August 1999, shortly after my positive diagnosis. Since then, I have not been on any meds as my CD4's and viral load has been well within margins. As of my recent lab results from this April, my CD4 was 358 and my viral load was 153,000 (highest load to date-previous high was 48,000). These results followed an extremely difficult and stressful time in my life. My doctor and I agreed we would review additional lab results in another month and determine what course to take at that time.
At the end of last year I have moved and am under a different physician's care. In conversations with my new physician, I know he differs in opinion from my previous Doctor regarding treatment plans. My previous Doctor would have put me on Trizivir alone. My new doctor originally suggested Sustiva and Combivir. Now, in my most recent office visit, while discussing the results of this lab work, the doctor asked me to think about different regimens that would work within my lifestyle, which may differ from his original thought.
Frankly, now I'm very confused... I do plan on starting medication treatment when the doctor and I agree the time is right, and by the results of my most recent lab tests would indicate that time may be sooner than later. So my question to you is, what type of program is the best? I'm the type of person that can adhere to any regimen as necessary. Although, my lifestyle is active and my job causes me to travel frequently and internationally, I don't foresee difficulty with any regimen. The confusing part is the conflicting information I have received from my HIV physicians about medications.
I truly want to approach this in the best way possible. Your input will be valuable to me.
| Response from Dr. Young
Thank you for your post.
Two drug class treatments with nucleosides (nukes) combined with non-nukes or protease inhibitors are prefered in the current opinion of most HIV healthcare providers. There are a number of options, based on your needs and feelings about the optimal tretments. Current options include the nukes Combivir, or the recently approved Epzicom or Truvata (as combination pills) with efavirenz (Sustiva) or a boosted protease inhibitor (such as Kaletra or ritonavir-boosted fosamprenavir). The efavirenz-based treatments have the distinct advantage of the lowest pill burden (2 a day) and excellent tolerability, though the need to take the pills prior to bed might be problematic if your travelling internationally frequently (when is bedtime?-- it'll shift everytime you travel). The PI-based treatments have increased pill counts (can be as low as 5 pills daily) and slightly increased risk of gastrointestinal side effects (though the newest PIs, atazanavir and fosamprenavir are very well tolerated). Consider now much the need to take medications with food impacts your lifestyle, since many PIs require taking medications with food.
The best advice is to discuss your options with your healthcare provider and local AIDS service organizations-- we now live in a world with multiple options for medications. This can make the initial decision somewhat confusing, but offers the promise of individualized care and treatment.
Good luck, thanks for reading. BY
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