I have been hiv+ for 6 years, and have held off conventional treatment as long as I could with various supplements. However, I feel it is now time to make the jump, but feel very uncomfortable making a decision about which regiment I should choose as first line treatment (AZT, DDI and DDC are not an option!). Although I have done a lot of reading, I still do not have a good feeling about having to go on a drug regimen, as it seems that clinical data suggests that drug failure is currently unavoidable. My doctor proposed the following for low drug toxicities and ease of adherence(which is a real issue due to my job): Sustiva, Viracept, and Zerit. I am familiar with the class-sparing controversy, and had some concerns about starting with all three class, on the other hand, it does make sense to attack the virus on as many fronts as possible. Also what do you think of SAQ+RTV or AMP+IND with the addition of a NRTI (such as D4T or ABA) or even an NNRTI? Do you have any data or anectodal evidence concerning a three class regimen? Thank you for your help I.A

We do have data on "three class" regimens from a few studies - and the results certainly suggest that they can work well. The uncertainty is whether they can work any better than regimens from just one or two classes of meds. If they do - then it may be a more successful strategy to use. However if they don't work any better - then it isn't clear that there is any important advantages and there is the big disadvantage of having less to build on for plan "b" IF there is ever a need to have plan B. There are clinical trials researching this important question - but it will be years before we have the answers in. So for now it'll be your informed intuition that will have to guide you.

From the regimens you are considering it is not clear what your concerns are about meds. The combinations you ask about are those using dual protease inhibitors. And the combination of Amprenavir and Indinavir has only a very small amount of info to judge from - altho in the small study that was done it did perform quite well. But it would be a fairly inconvenient regimen to take - since the Indinavir would still need to be three times a day on an empty stomach. And we do have easier regimens that appear to work very well, without such restrictions on you.

The Riton/Saquin has been well studied and does quite well - we are up to year 3 on the study and there are those who are still very well controlled on it - and it is fairly easy to take. There are those who do have elevated lipids (cholesterol and triglycerides) from this combo - but there are those who don't and so far, for them, it is working well.

Adding a third drug to the dual PI combo is often done - and one study suggested you can add the third drug at the beginning - or sometime during the first 12 weeks or so based on your response to the two drugs - either way can be successful. If your viral load is over 100,000 at the beginning however, most would recommend starting with a triple combo at the outset. And the third drug can be a nuke (like d4T or abacavir as you mention) or a nonnuke - there are studies suggesting both approaches are successful. And pros and cons to consider for each.

As for whether to do a one, two or three class approach - this was recently addressed in the Aug 2 question posting under Class sparing vs hitting hard (or a title similar to that). So consider checking that answer out for more discussion of this key controversy.

Many options. Many ways to create successful suppression. It might help to list what you are looking for in meds - what characteristics you want, and don't want - as one way to narrow the options that fit what you are looking for.

Good luck. CC