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About PPD
Sep 6, 2004

Dear Dr,

when doctors mention that the first line ,second line ,thrid-line treament what does that exactly mean how is that work (i mean usually with how many medications , how many line treatment do we have in total )

i have PPD + (not active TB) what should i do? Does the medicin for TB will interact with sustiva and others medications i am very scare about this result(i have PPD + skin test) . if i have a good control of my VL and CD4 >500 shuld i worry about TB infactin will occur !

Thank you very much !

Response from Dr. Pierone

First line simply means the original regimen used for HIV treatment. We usually talk about second line therapy after someone has developed virologic failure of the first regimen and needs to have therapy changed. When virologic failure occurs there often is virologic resistance and cross resistance to other antiretrovirals in the same class present. This cross resistance limits the choices for second line therapy. Of course third line therapy will be needed if the second line regimen fails and do forth. The take home message is that the complexity of treatment increases and the chances of success diminish as one burns through courses. So prevention of viral resistance is of paramount importance. For someone with a postitive PPD, but no signs of active tuberculosis, the usual treatment is INH or isoniazid. This medication has minimal interactions with HIV medications. Good luck!



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