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The Correct ARVs?
Jul 2, 2006

Abount one year ago, my girlfriend was diagnosed as HIV-positive. She is Vietnamese and we live in Cambodia.

At the time, her CD-4 was 262. Rightly or wrongly, we were convinced to start her on ARVs at the time.

Due to the lack of available healthcare, we decided on the ARVs from my research on the internet and an Australian nurse. Our decision was to go with Triommune, which is Nevirapine, 3TC, and d4T.

It seems that I read somewhere that a Nevirapine-based regime is not recommended for ARV-naive patients. However, we were forced to go with this primarily due to its low cost.

Other than an initial rash and mouth ulcers, the patient is doing quite well with her VL being undetectable within a few months of starting ARVs. In addition, her CD4 had risen to about 500 three months ago.

I have subsequently been able to get her into a CDC-backed program in Phnom Penh.

The question that I have is if we are doing a disservice to her by going with the cheapeest and most readily available ARVs for her as opposed to another regime. I am an American and although I do not have unlimited funds, I would spare no expense to ensure that she is receiving the best care that she can.

Thank you for your time and advice.

Response from Dr. Wohl

Nevirapine is a fine choice as a component of initial therapy and in most of the world there are few other choices. The nice thing is she seems to have tolerated the medication and had a great response according to the labs.

Also Trimomune is sustainable. It is cheap and readily available allowing you to save your money in case she needs another regimen down the line, expert consultation or other unexpected medical expense.

She definitely should have started meds when she did.

DW



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