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First-line Meds when Hepatitis C infected?
Jan 1, 2006

What a great site you guys have. So much info and help. My girlfriend will begin meds soon as her last 3 series of test have indicated its about time. She is Hep C+ and is currently taking presciption methadone. Her cd4/vl has been trending downward with last result of 385/8060. Could you please give a few suggestions as to treatment options for HAART. Thanks

Response from Dr. Pierone

Hello and thanks for posting.

In general, there has been greater use of Truvada as the nucleoside backbone in starting regimens because of fewer side effects compared to the other options. Sustiva is typically used to complete the HAART regimen because of its convenience and effectiveness. This results in a 2 pill once daily regimen that is tough to beat.

But there are reasons to choose other starting combinations. If adherence is likely to be a problem many clinicians may choose a protease inhibitor based cocktail. When adherence is poor, resistance is more likely to occur with Sustiva (or other NNRTIs) compared with boosted PI therapy. If viral load is very high or the CD4 count is extremely low, boosted PI therapy may be a better choice. Viramune has a higher rate of liver side effects compared with Sustiva in women with CD4 counts above 250 cells and this would also favor the use of Sustiva for your girlfriend. But Sustiva can cause birth defects so the potential for pregnancy has to be factored in to the selection

Another issue that must be addressed is the drug interaction with Sustiva (and other meds as well) that results in lower blood levels of methadone. When HAART is commenced the dose of methadone may need to be increased to prevent narcotic withdrawal symptoms.

I hope that this information helps and best wishes to you and your girlfriend!

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