Dear DRS: I am still in shock - and with out going into long details, here is my question. After 18 years of living with this aids thing out there I found out 4 days ago i have the bug. My throat has been sore for 3 months and my DR. could not figure out why. Than last week I got a bad case of the shingles. Several blood test later I found out I have a T-cell count of 109 and a viral load of 134,000. My lungs feel like they have cob webs in them. So he puts me on MEPRON right away and tells me he is going to start me on - Sustiva, epivir & zerit tommorrow. My question is this. Is this the best combination for new cases like me just starting out. I have severe allergic reactions to any sulpha and pennicillan drugs. Please help!!!! THANK YOU

Well - while you are dealing with the shock of hearing a positive result - you sound like you are in good hands.

First the antivirals. The triple regimen that has been recommended is one for which there is very impressive data on how well it can do. We participated in a study that looked at those three antivirals (also called d4T, 3TC, and efavirenz) in combination for those just starting out - including those with a viral load over 100 thousand. And the preliminary results are striking - virtually everyone had a viral load below 50 copies by six months - which is the goal for all of our successful regimens. And there was more than a 150 T4-cell increase during that time on average. And while no combination is perfect - no one needed to drop for the side effects - altho in other large studies about 3% of people do not tolerate the side effects of Sustiva that happen in the first month (rash and mood disturbances...). The 3TC appears to be about the easiest of all antiviral to tolerate. And the zerit is similarly easy to tolerate - over time a few percent can develop tingling/numbness of the hands or feet (called neuropathy) but that usually doesn't happen for months - and never happens for many who take the drug.

I don't know where you live - but there is always research going on to see if we can do even better than this combination. And you might check out the options if there are any near where you are. But if there are none - this is one of the more impressive combinations out there.

As for the Mepron - given your sulfa allergy - we would avoid bactrim - there is an alternative pill called dapsone but it does have a sulfa base so there is some rationale to avoid it as well if your prior reaction to sulfa was severe. Some have managed - using a process called "desensitization" to tolerate the bactrim even if they had an allergy to this in the past - but again depending on how severe your prior reaction was, you may not want to chance this. Other than Mepron, the other choice is inhaled pentamidine. Both work - and the decision of which to use is up to personal preferences.

But the good news is that - since you have never had PCP - and are soon to start some effective combo - and in the next year are likely to have a T4 count well above 200 - you probably won't even need PCP prophylaxis. Since in those who get their T4 cell counts back up - even off prophylaxis no one is yet seeing much if any PCP happening...

Good luck. CC