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Sep 22, 2004

Dear David:

Recently you provided this answer: 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.


As a physician I know what you meant by XTC (i.e. either 3TC or FTC), but I also know you did not mean that the person in question should use an illicit drug as part of his or her initial HAART. I suppose that chip and software vendors have conditioned us to think like this by numbering versions of their products in this fashion.

Best regards, John DesMarteau, MD

PS: You may have already received a lot of messages on this.

Response from Dr. Wohl

Right. I am not advocating application of the club drug ecstasy as an antiretroviral. I meant either 3TC or FTC, as you surmised.



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