I am a 38 year old male diagnosed hiv pos in march live in spain, have a good contact with my doctor. language sometimes makes me nervous i hope i understood everything corect they tell or explain to me. Had two test cd4 645 viral 18500 and early july cd4 640 viral 19000 my doctor tells me i have to start medicine. i am nervous don't no which comb. is right for me. My doctor thinks azt + 3tc + efavirenz. Sustiva will be available here in sept. in one tablet instead of taking 3 (once a day at nighttime) next week i go for an other viral test result early sept and i had to promise my doctor to start med at that time. efavirenz is a new med is there enough known about it. is it safe to take and would you recommend it or do you recommend another combo? if i'm resistant to efavirenz does that mean that i am resistant to azt and 3tc as well because i take them in combination and can not take them later in an other combo or is that the case in any cocktail? thank you very much for your help your forum has been a great help to me.

Glad the forum is of help to you and other around the world.

First - while it is OK to start antivirals at the viral load and CD4 count you describe - it is a bit unclear if you describe feeling pressured to start. With your T4 count you are in no immediate risk of anything happening to your health... and in no risk for a good while. So you should not feel pressure to start - you should feel that you can explore the positive results, and the possible negative concerns about starting now. And decide for yourself if you are ready. The meds are getting simpler - if I understood what you wrote (I did a bit of editing of the english) - you might be able to take advantage of a newer form of the sustiva so that you would only need to take it just one pill once a day instead of three capsules once a day. And the AZT/3TC is already in one capsule - so your combination would be one capsule in the AM, and two at night, every day. Which is pretty easy to do... IF you are ready. Are you?

Now - there are several reasons why we are enthusiastic about treating when people have higher CD4 counts and reasonable viral load levels - including the recent observation that when people start with a CD4 count above 500 - the combinations might be even more successful at controlling HIV - and MIGHT allow any combination to work even longer than if you waited until your T4 counts drop. But the meds only work their best when people take them every day - each dose. And meds can have side effects. So you must be ready to include even this simple regimen in your life - and feel you have a great relationship with your doctor so you can discuss any possible side effects that you might have. You might consider taking something else - like maybe a vitamin? - every morning and night just to see how well you would do at taking pills every day twice a day. Since most have never done this before...

The combination you mention is one that has been studied in several large studies - and does very well. With very impressive results. Among the best we have at the moment. Not perfect of course - nothing is. But among the most reliable in doing what we want to do in controlling HIV with few side effects in most take it.

Now - about resistance. The azt and 3tc are one type of antiviral - and the Sustiva/efavirenz is in another class. I don't know if you are concerned if you are already resistant to Sustiva - but we do know that in studies of those never on meds - maybe 5% are resistant to these meds already - as a result of the HIV that you initially started with. And we can test for this. But there is no overlap in the resistance of these three meds - and if you do develop resistance to one of them, there are other meds you can consider in the future.

But the best way to ensure you don't develop resistance is to take the meds every day each dose -- and to know that if there is a problem with that - you have someone you trust who you can call to see what can be done. Since we do have options to help with any side effects...

Hope that helps.