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To start or not to start?
Jun 5, 2005

I've just been diagnosed with HIV (VL@48000/TC@575). My doc is recommending aggressive treatment w/ Truvada and Sustiva. I'm scared of the side effects I've read about from Sustiva. Any suggestions? Should I consider holding off starting meds?

Response from Dr. Wohl

I am not so sure I would start therapy at this point unless you were having symptoms associated with HIV infection (e.g. thrush, weight loss, unexplained diarrhea etc) or were in the throes of acute HIV infection. Your Cd4 is high and your viral load average.

IF therapy is indicated for some reason, the combo of Truvada and Sustiva is a good one. The potency of this an very similar regimens has been demonstrated in a couple of major studies and the once a day dosing is convenient.

As far as side effects, most people do not have major problems with Sustiva. In clinical trials, less than 10% of people need to stop the drug due to adverse effects. Also, the first 4 weeks are the worse for most. That means if you are having troubloe, chances are it will largely resolve over a month.

If central nervous system problems (dizziness, foggy-headedness, sleep disturbance, etc) do not abate, a switch to nevirapine or ritonavir boosted atazanavir can be easily accomplished.

But, given what you write, I would wait.

DW



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