dear doc, i write you to have just an idea on which are the side effects about this cocktail, the patient is a male with over 900.000 and 40 cd4, against a lung infectione they gave him co-trimoxazol and codeina fosfato, than this cocktail 1 norvir 1 emtriva 1 virid 2 rayataz. thank you for your answer. J from europe

Dear European J, thank you for your post.

I'm certainly in agreement that the patient needs to start on HIV medications. He has advanced AIDS with a very low CD4 cell count and very high viral load. From the sounds of it, he may have had pneumocystis pneumonia as well- as such co-trimoxazole (Bactrim, Sulfatrim) is very much indicated.

The regimen of tenofovir (Viread)/ emtricitabine (Emtriva, FTC with ritonavir (Norvir) boosted atazanavir (Reyataz) is one that is commonly prescribed here in the US for first line treatments. The regimen is usually very well tolerated- tenfovir rarely causes clinical side effects, though in patients with kidney disease, the dosing and toxicity needs to be monitored. FTC likewise is usually very well tolerated, a small percentage of patients develop increased pigmentation (freckling) of the hands. Norvir/atazanavir can cause mild gastrointestinal upset and characteristically can cause yellowing of the eyes and skin in a small percentage of patients.

The most important issue with this regimen (that is sometimes forgotten by doctors and patients alike) is the strong requirement to take the Norvir/atazanavir with food and to not use antacids because of the potential to seriously lower the amount of drug that is absorbed (increasing the risk of treatment failure). This may be particularly true when combined with tenofovir, since tenofovir lowers atazanavir levels slightly as well.

I hope this helps, thank you for reading. BY