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On Starting Meds (treatment naive) Apr 6, 2001 Hello I am a 28 y.o. male and I am about to start treatment (Ive been poz since dec 98,but chose to delay any treat) My las V.L was above 50k and my cd4 where 450 or so . But V.L. is increasing and my doctor has suggested to start meds...Never had any O.I. yet,but I am really worried about possible drug side effects...The Big Q..: WHAT IS THE BEST RECOMMENDED TREATMENT (regarding what kind of drugs/regimen) FOR TREATMENT NAIVE PATIENTS AS MYSELF with minimun side-effects plus proven effectivity? I think YOU are the experts i need to ask before taking any desition with my MD,so I can Have a clue!! :)) THX THX THX A LOT Curious1 :) |
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| Response from Dr. Young
 Thanks for your question; first line therapy options is a complex and very individualized decision process. In general terms, we typically start people on one of three different strategies, all involving two nucleosides (either d4T/3TC or ZDV/3TC (aka Combivir). (1) in combination with a non-nuke, such as efavirenz or nevirapine; the former has really robust data to support it's use; tolerability is generally excellent and pill count is very good. Some folks rarely have some difficulty with the central nervous system symptoms associated with efavirenz, but this usually dissappates with time (2) in combination with a single protease inhibitor, such as nelfinavir- well tolerated, but with higher pill count and some mild-moderate gastrointestinal side effects. We have several hundred patients in our practice on this type of regimen with excellent tolerability and results. (3) in combination with a "boosted" protease inhbitor (such as ritonavir/indinavir). These are the new kids on the block and have shown dramatic potency in clinical trials; such potency should predict long-term success; this statement is tempered by some increase in side effects (due to ritonavir) and elevations in blood lipids (cholesterol, triglycerides). The details of choice depend alot on the potential side effect or toxicity profile of any particular regimen, pill counts, timing of dosing and/or any meal restrictions (mainly for ddI and unboosted indinavir). One shoe fits one; talk closely with your doctor, and seek advice from PWAs or your local advocacy groups. BY | ||
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