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Starting Meds
Jan 4, 2006

I just started my meds about a month ago. I was infected for about 1 1/2 years before i hit full blown AIDS. My t-cells went down fast but my viral load was alway somewhat low (highest being 20,000). When they put me on meds, they started me with 2 reyataz, 1 Norvir, 1 truvada once a day. Is that a good combination to pick, and is it ok that i only take my meds once a day?

Response from Dr. Young

Thanks for your post.

The combo that you've listed is a quite popular one in the US for first-line treatment; overall, the anecdotal reports have been very favorable. Tenofovir/FTC (Truvada) with ataznavir(Reyataz)/ritonavir (Norvir) has some limitations that make it an alternate in our clinic.

First off, there are few clinical studies with the combination, as such, the actual rates of side effects are not well characterized- it can be expected that up to 5-10% of patients will experience jaundice or scleral icterus (yellowing of the skin and eyes). The risk of these appearance-related side effects have been of concern to some of my patients.

Because of the drug interactions between tenofovir (part of Truvada) and atazanavir, ritonavir must be used (though the resultant atazanavir levels are lower than without tenofovir)-- the addition of ritonavir can be expected (though not yet proven) to increase lipids to some degree, potentially reducing the favorable cholesterol and triglyceride profile of 'taz. Lastly, the combo, while can be taken once-daily, must be taken with food (and without antacids) to achieve optimal drug levels.

Because of these limitations, we'll tend to use fosamprenavir (Lexiva, Telzir-- usually with ritonavir) in combination with Truvada (to avoid the negative drug-drug interactions and food requirements). Alternatively, I'll tend to use abacavir/3TC (Epzicom, Kivexa) (instead of tenofovir) with atazanavir regimens, in order to keep my atazanavir levels at their maximum potency.

Until large clinical studies, these thoughts are just that-- comparative clinical trials will one day help us really understand the relative merits of particular drug regimens.

I hope this helps. Be well, BY



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