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Starting treatment for 1st time - which PI to choose?

Apr 15, 2007

I am a 45y.o. male. I was diagnosed HIV+ in November 2003 (had tested negative in March 2003). My doctor has taken a wait & see approach since then, which I have been comfortable with and my health has been fine (occasional cold, flu, sinus infection, etc.). My CD4s have been in the 475 - 575 range since my diagnosis (one drop to 372 in March 2005) and my viral load, which was 50,000 then 70,000 initially fell to a stable range of 5,000 to 20,000 (once measuring at 444) over the past 3 years. My dermatologist just found a KS lesion on my heel. My doctor feels its time to start meds (my latest counts are CD4 506, VL 22,000, %age 27%). Hes recommending an initial treatment of PI, e.g., 1) Kaletra + Epzicom (or Truvada) or 2) Reyataz/Norvir + Epzicom (or Truvada) or 3) Lexiva + Epzicom (or Truvada). I am really anxious about starting. I am nervous about the yellowing side effects of Reyataz and the diarrhea that Kaletra can cause. (I was put on a 30-day morning after regimen once 5 years ago with Kaletra (+ Epivir and Viread) and had (sometimes uncontrollable) diarrhea. Any thoughts?

Response from Dr. Pierone

My first thought is why go with a protease inhibitor for first line therapy?

NNRTI-based therapy (Atripla for example) generally outperforms PI-based regimens and is a whole lot easier to deal with. Unless there is some reason not mentioned in your post, it seems logical to go with a simpler, less toxic, more effective regimen.

But if one feels compelled to use a protease inhibitor from the get-go, then Norvir, Reyataz, and Truvada has the best profile. If your eyes become yellow from the Reyataz, then a switch to Lexiva (with 100mg of Novir, not 200mg) would make sense.

Let us know what you decide to do and how things turn out. Best of luck!

What now after Combivir/Sustiva (stocrin) failure?
doi need to go back on meds

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