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First Line Therapy For Treatment Naive
Jan 16, 2005

Hello Doctor,

My specialist is recommending that I begin therapy within the next few months. My current CD4 cell trend is about 310 to 340 (18%). In the four years I've known my HIV status my viral low has always remained very low, around 1000 to 2000 copies. I recently had a genotype done and it showed I had "wild type" virus with no mutations which I know is favorable news. I'm also completely asymptomatic and otherwise in good health. My doctor considers me to be a very slow progressor but she does feel I'm at the threshold of initiating therapy. Based on this, is there a "gentler", easy to take regimen for someone with a very low viral load like myself? I have all the usual concerns about possible drug toxicities and want to make the best choice possible. Also, do you feel I have a good long term prognosis?

Thank You for all your help, Chris

Response from Dr. Pierone

Hello, it does appear that you have an excellent prognosis. In general, NNRTI-based therapy has fewer side effects than protease inhibitor-based treatment. Viramune has is generally well tolerated, but concern over liver toxicity has led a trend towards greater use of Sustiva in this class. Truvada has fewer side effects than Combivir and Epzicom (but does not sacrifice strength) and there has also been a trend favoring this agent.

The standard of care for treating HIV infection is to use a three drug regimen, but research is being done on streamlined regimens (single and dual agent) to see if HIV can be controlled with less risk of toxicity. This is clearly in the experimental realm (just where big pharma would like to see it stay) at present and is not recommended outside of clinical trials.

Thanks for posting.


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