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Choosing Your MedsChoosing Your Meds
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Hiv+ Six months ago
Jul 9, 2006

Hello, and thank you for your help, I am a recently diagnosed 35 yr old male, cd4's @ 420 VL @ 300,000+, and just got over a bout of shingles exceptionally well with acyclovir 800mg x 5 tabs x 7 days...My doc wants to start meds already...choosing a first line of Kaletra, Viread, and 3TC(lamivudine)...I am being offered this cocktail as a clinical trial, what do you think?

Response from Dr. Young

Thanks for your post.

First off, I'd agree with your doctor about the initiation of treatment-- you've got a CD4 count that's approaching the conventional threshold (~350) and a pretty high viral load (a predictor of more rapid than average CD4 decline).

My favorite approach for first-line patients is to offer clinical trial options-- this way the community learns of the benefits and liabilities of treatments; to the patients, there's the benefit of free medications and HIV-related health monitoring.

The regimen that you're offered is very potent and generally very well tolerated. I've advocated the use of boosted PIs (such as lopinavir/ritonavir-- Kaletra) for many first-line patients, particulary becuase of the reduction in risk of drug resistance. The combination of tenfovir (Viread), 3TC and lopinavir/ritonavir doesn't have the lowest pill count, but it's pill burden of 6 pills daily isn't prohibitive. Be sure that your doctor evaluates your kidney function and blood lipids before and during treatment, since these represent the characteristic toxicities of the regimen.

I hope this helps, let us know how your treatment goes. BY

how much risk
which med should I stop?

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