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Should I start meds
Feb 25, 2006

Greetings from Denver, Colorado. Here my question. I was seroconverted in November and am on the CORE1 and EBS Studies here at Uninversity Hospital at my last 2 visits on Jan 19th my Tcells were at 424 and my VL is over 650,000 a month later my tcells were at 221 and VL was over 750,000 is now a good time to go on meds? I got my genotype back and it showed that I was resistant to NNRTIs but show no resistance to PIs or NRTIs so my doctor is recommending that I go on atazanavir with a ritonavir booster and emtricitabine/tenofovir disoproxil fumarate is this a good combination I am also taking valproic acid for bipolar disorder. Or is the another combination that you recommend like instead of Atazanavir/Ritonavir combo maybe lopinavir/ritoniavir with same NRTI combo

Thank You

Response from Dr. Young

Thanks for your post, neighbor.

Thanks too for participating in the clinical trials at the U-- now to your questions. First off, you are in the unfortunate minority of patients who have acquired drug resistant virus (which is why it's really important to get this testing before starting on antiretroviral medications).

I'd think that if your CD4 count remains below the 300 level (especially if your viral load stays as high as it is), then starting treatment would be recommended. Clearly, given your resistance to NNRTIs, a boosted PI regimen would be recommended.

The atazanvir/ritonavir +tenofovir/FTC combo is widely prescribed-- recent results of the BMS-089 clinical trial are affirmative and support good tolerability and toxicity. In patients like you with very high viral loads, I tend to shy away from a tenofovir-atazanavir combo because this combination results in a loss in the atazanavir levels; I believe that having optimal levels are essential to long-term performance of drug regimens. Because ot this, I'll tend to use tenofovir with either lopinavir /ritonavir (Kaletra) or fosamprenavir (Lexiva)/ritonavir; or use atazanavir with an alternate NRTI (AZT, abacavir) with 3TC or FTC.

I hope this helps. Write back and let us know how you're doing. BY



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