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!
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