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Very scared....
May 8, 2006

Hi. Please can you answer the follwoing questions, as I am so very scared. I am new to HAART, and wish to know the following (For background, I may have been infected over 10 years ago): 1) Does Peripheral Neuropathy lessen or completely disappear with the introduction of HAART (I have been affected by this recently, in both my hands and feet)? If not, are there are drugs available which help to reduce the pain? 2) Also, I am very concerned about my lipid profile (My viral load currently stands at less than 10, and my viral load is approaching 1 million). Which drugs would be best in this instance? I have been advised that Truvada + Sustiva is relatively harmless, however, would the length of my infection have any bearing on this? Also, I gather that Truvada + Reyataz + Norvir has one of the most lipid friendly profiles of all the combination therapies? Is this the case? I am more tempted to opt for this due to the current situation with my CD4 count/viral load. 3) One last question - if you choose a Protease Inhibitor for your first line therapy, does this leave you with many treatment options? I have been told it is best to opt for an NNRTI (Such as Sustiva) in the first instance, and then "move up" to a P.I. if viral resistance occurs - is this a sound theory? Sorry if these sound like stupid questions, but owing to my current situation, I wish to empower myself with as much knowledge as possible. God bless you. A.

Response from Dr. Pierone

The development of peripheral neuropathy as a complication of AIDS can be due to either to the direct effects of HIV itself, or sometimes to an opportunistic infection like CMV. In either case, the problem often improves or resolves after HAART is commenced.

I think you meant to say that your CD4 count is less than 10 and the viral load is nearing a million. In this case the Norvir, Reyataz, and Truvada combination is more appealing. Post hoc analysis of the some of the Truvada + Sustiva studies showed high response rates, but the one group that was more likely to have clinical failure and develop drug-resistant virus where those individuals with very high viral load and low CD4 counts.

Use of a protease inhibitor as front-line therapy leaves the NNRTI class as a treatment option in case of virologic failure (which is unusual when ritonavir-boosted PI therapy is utilized). The use of an NNRTI up front leaves the PI class available in case of clinical failure. NNRTI-based therapy is most often used first because of convenience, high response rates, and better tolerability.

Thanks for posting and best wishes!

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