Low CD count
Mar 20, 2005
If initiating therapy with a CD count of less than 50,and a very high viral load, is there a combination of meds which you would strongly recommend, i.e. is there a regimen which has been clinically proven to be better for those with a low CD count, and help to quickly reduce viral load?. In this instance, would a Protease Inhibitor offer a greater barrier for resistance than an NNRTI? Another concern of mine is tolerability, so I would greatly appreciate your thoughts on which regimens are easiest to take.
As I live in Europe, I see that Truvada has now been licensed for approval over here - would this in conjunction with Sustiva prove to be a potent combination for a low CD count, and one which would offer a very high success rate?
Many thanks for your all help.
This web site truly is a godsend.
Response from Dr. Young
Thanks for your post and kind words.
I'm happy to hear that we're reaching readers in Europe.
In patients with very low CD4 counts and high viral loads, both non-nuke-based and boosted PI-based regimens have been shown to be very effective (as effective as in patients with higher CD4s or lower viral loads).
Boosted PIs are, as you allude, probably better than NNRTIs with regard to the risk of developing drug resistance. I tend to favor the use of newer boosted PIs in this circumstance, particularly fosamprenavir (Lexiva, Telzir) and in some cases atazanavir (Reyataz) because of their lower pill count and dosing frequency. Because of fosamprenavir's lack of diet or drink restriction nor need to avoid proton-pump inhibitors (anatacids), this medication has gained significant popularity in our clinic here in the US.
A very recent meta-analysis by Bartlett (presented at the CROI meeting last month) suggests that while NNRTI and boosted PI regimens are similar in viral load suppression, there is a significantly increased CD4 count rise for boosted PI regimens; moreover, the differences in pill count between the NNRTI and boosted PI regimens (once associated with poorer outcomes) is no longer a measure of risk of failure.
Truvada and efavirenz (Sustiva, Stocrin) has been studied in the ongoing Gilead 934 clinical study (see TheBody's conference coverage for details). This study has shown excellent results, with improved initial tolerability compared with ZDV/3TC (Combivir), though similar durability among patients who tolerate the medication. In either case, resistance profiles look acceptable though patients who do experience failure frequently have resistance to two classes (NNRTI and NRTI) of medications.
I hope this helps-- feel free to write back with additional questions. BY
Get Email Notifications When This Forum Updates or Subscribe With RSS
- What Types Of Cells Does Hiv Infect And What Kinds Does It Destroy?
- Exercises To Get Rid Of Buffalo Hump
- Cases Of Wife Contracting Hiv After Husband Had Visited A Prostitute
- Are Certain Blood Types More Likely To Get Hiv?
- Can A Man Give A Woman Hiv By Pulling Out Before Ejaculation?
- Chances Of Getting Hiv From One Time Exposure
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.