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Medication Advice
May 21, 2005

Dr. Young, I was diagnosed 3 years ago. My CD4 was 550 at 30%. Last week, I was 440 at 18%. My viral load stays pretty level. My doctor recommends starting therapy because of the low percentage. My doctor recommends Reyataz and Truvada. What are your thoughts on the two? Thanks for your time, Tom

Response from Dr. Young

Thanks for your post.

Your CD4% is in a range where I would begin to consider initiation of treatment, though your absolute CD4 count is still in the normal range. This probably means that the time to start is soon, though waiting for a repeat set of labs in a month or two wouldn't be a terrible thing, if your on the fence.

As for the treatment regimen, Truvada (tenofovir + FTC) should NOT be administerd with atazanavir (Reyataz) unless taz is boosted with ritonavir (Norvir). This is because tenofovir significantly lowers the levels of atazanavir into a range where it is likely not to work as well as needed. Be aware that this regimen must be taken with food, since taking atazanavir on an empty stomach will result in a very large decrease in the amount of drug absorbed. These points said, the combo of Truvada + atazanavir/ritonavir should be a well tolerated once-daily regimen.

It's my personal preference to use atazanavir/ritoanvir with other once-daily nukes (NRTIs), like Epzicom (abacavir/3TC) since it just doesn't make sense to me to knowingly decrease drug exposure when other alternatives are feasible. Alternatively, if one really needed or wanted to use Truvada as the nuke backbone, then there are other protease inhibitors that can be used without the drug-drug interaction-- particulary fosamprenavir (Lexiva, Telzir) or Kaletra. Both of these PIs offer once-daily possibilties, though fosamprenavir is probably better tolerated as a once-daily PI (and doesn't have the food restrictions of atazanavir or Kaletra).

Hope this helps, BY



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