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US internship and first-line medication
Nov 7, 2005

Hello,

I am a 21 year-old, living in England, who was diagnosed almost three weeks ago. It was a terrifying bolt from the blue - I was convinced that I had never had unprocted sex, until I remembered one time last sumemr when I was too drunk to know what was going on. I'd been living with the virus for over a year, through my final year at university, and, to put it bluntly, my whole world fell apart when I heard. I was suicidal for about ten days. I'm slowly beginning to get things back on track, but it's still hard not to feel robbed of my future; nor that my life can now only be spent in secrecy and shame.

My doctor says that there's no hurry to introduce treatment, even though my initial CD4 count was 'just under 300'. He thinks that this was a freak result, since it was tested the morning I heard and I had spent the previous evening out drinking with friends until 3am (!). I don't know what my viral load was.

There is a chance, however, that I will need to start treatment in the next few months. I'm currently on a gap year and hope to be starting law school in September 2006. One of the things I've arranged is three weeks' work experience in New York: is it now impossible for me to go on this? I'm also supposed to be backpacking with friends in India and China next summer before starting law school - should I still go on this or should I keep my travel plans a little less strenuous?

My second question is: what would you recommend as a first-line treatment? I am confident that I can maintain 100% or virtually 100% adherence, subject of course to the usual factors like pill burden, side effects, food requirements and so on. Simplicity and ease of use are key.

Many, many thanks for your help with these questions.

Response from Dr. Wohl

Most of the questions you ask, you will end up answering yourself as the fog surrounding a new diagnosis of HIV starts to lift. The most important thing is how you are feeling. If you are feeling well, that is the most important thing.

Can you go to NY? China and India? Why not? If you felt you were well enough to go the day before you found out you are HIV+, why not the day after?

Certainly, if you need to start meds right away (there are few HIV treatment emergencies - it can often wait a few months) you will need to plan. After a few months of therapy you will know if it is working well and that you are tolerating it.

There are several choices regarding initial therapy. Given your wayward tendencies a medication that needs refrigeration is probably unwise. Truvada and Sustiva (Stocrin) is a nice once a day choice of two pills before bed. Sustiva can mess with your head at first but in most people this passes in the first weeks (good thing you are on a gap year).

DW



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