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Trying to Decide on a Regimen

Sep 7, 2004

I was diagnosed with HIV on 6/25/04 with the infection very likely having happened late 11/03 (my last test was negative soon after this date). My labs over the summer have shown a relatively low T-Cell Count/high HIV count:

6/29/04 = 433/193,000 7/8/04 = 487/586,000 7/22/04 = 438/678,000 8/12/04 = 357/468,000

Both my doctors feel that meds are necessary, but disagree on what type. One doctor suggests either Kaletra + 2 nukes or Sustiva and Trizivir. The other suggests a less aggressive approach, with Sustiva and Truvada (Emtriva/Viread combo). All of this kind of makes my head spin. I want the best for my long-term health while minimizing side effects. What would you suggest?

Response from Dr. Wohl

This is a feet-to-the fire question that you will get a number of different answers to, perhaps even on this site (so, it may be worth asking each of us). None of the choices recommended are bad and all will probably do what you really want - reduce the viral load to undetectable or nearly so and raise your T-cell counts.

Clinical studies have demonstrated that d4T (or AZT) + 3TC plus Kaletra works very well over a period of years. The data look equally as impressive for AZT + 3TC + Sustiva or Tenofovir + 3TC + Sustiva (the latter has recent long term data). These rgimens have proven to be effective even in people with high viral loads, like you. There are less data on FTC but most of us have come to believe this will work at least as well as 3TC. Of all the regimens you list Trizivir + Kaletra is the least studied. It should work. Whether it is overkill is not known.

To date, there are not results from a big Godzilla versus King Kong study of Kaletra versus Sustiva. The AIDS Clinical Trials Group is in the midst of such a study but the final analyses are way off. In the absence of data, it comes down convenience (pill count, dosing frequency, pill size) and tolerability. If you are a 58 year old man with high cholesterol and diabetes, Kaletra may not be for you. If on the other hand you are a Gulf War vet with some serious PTSD Sustiva may not be your cup of HAART tea.

A minimum of 2 nukes (such as AZT or Tenofovir with XTC) plus either Sustiva or Kaletra should do you well.

DW



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