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Friend in need
Nov 15, 2005

Hello Dr Young,

I have a friend who is HIV positive with a CD4 count of 222 and VL of 56000. He was told by two different doctors to start on a regimen of either 1) Sustiva / Truvada or 2) Combivir / Viramune He has fairly low platelets and has tested positive to HSV. Which in your opinion is the better regimen to begin with.

On a more personal note, I read your bio and found it very interesting and similar in some regards to my own life. I completed an electrical engineering degree with a biomed minor and then did a PhD in biomedical imaging (MRI, CT etc). Then I travelled the world for 6 months. On my return I decided to enrol in medical school which I have now commenced (at age 27!). I am interested in what you rate better out of academic PhD research or medicine?

Thanks for your help and keep up the good work!

Michael.

Response from Dr. Young

Thanks for your post and interest, Michael.

Among the two differrent options for your friend, I'd vote for number one. The combination of once-daily combo tenofovir/FTC (Truvada) with efavirenz (Sustiva) is on most guidelines preferred list (including our own DHHS). AZT/3TC (Combivir) and nevirapine (Viramune) is not a bad alternate, though is dosed twice-daily and has a slightly greater risk of causing some side effects. (I'd encourgage a search of our form about specifics of the side effects of each of these drugs.)

As for the PhD vs MD question-- a quick summary is thus:

Academic basic research puts you in touch with the most cutting edge of research-- it's detail oriented and labor-intensive. The buzz is a very high one, when you hit pay dirt. The problem is that funding can be problematic and the days of slogging far exceed the days of elation.

For me, clinical medicine (and clinical research) offers a more steady-state satisfaction of seeing patients improve their quality and quantity of life; I'll never become a member of the National Academy of Sciences or win the Nobel, but there is an undeniable ego-satisfaction of knowing that you can help people.

I think that it's the life experiences that you have (as well as the academic ones) that will enrich your perspective on patient care and any research that you ultimately decide to do with your medical degree.

Good luck, MS1, drop a note from time to time. BY



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