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thanks for replying
Jan 7, 2006

thanks for replying because your kind gesture can save someones life. i just wanna ask you one thing not bother you that much my friend whose cd4 is 165 and vl is 2.5million .he is also a diabetic .i want to ask what drugs should i start and how should i then treat his diabetes whicg haart therapy is best for him.will he have to come on insulin.please let me know the viral drugs which i should try on him thanks. DR SHEHARYAR

Response from Dr. Young

Thanks for your follow up and kind words.

Your friend should certainly be considering starting HIV medications with a CD4 count in the AIDS range and a very high viral load.

He should be starting on the most potent, and well tolerated three drug regimen possible. By current conventions, this would mean a regimen of 2 nucleoside drugs with either a non-nuke (efavirenz/Sustiva) or a ritonavir-boosted protease inhibitor (lopinavir/Kaletra; fosamprenavir/Lexiva or atazanavir/Reyataz are popular ones in the states).

The possibility of complicating his diabetes is notable-- to this extent, some of the protease inhibitors can exacerbate sugar control, but generally not to a significant degree. The other issue to note is the possiblity that your friend either has, or is a risk of developing kidney disease (because of diabetes)- tenofovir (Viread or Truvada), if prescribed, should be monitored closely.

It's important, as you suggest, to try to tailor medications to a patient's particular set of needs. Because of this, please make sure that your friend gets good medical advice.

Good luck to you and your friend. BY



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