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So many choice so little time

May 4, 2007

OK, my Doctor thinks its time to start meds. My background: Im a 38 y/o Male & 100% asymptomatic (feel great, eat well, exercise and no co-infections). I have been HIV+ for 15 years. I have graphed my numbers for the past 10 years with a T-Cell range of 300 500 +/-, VL from 8 12K +/- & percentage 18 24%. My Doctor doesnt want my string of success/stability to suddenly change, so he has changed his wait and see approach to lets start before things take a turn for the worse. Like many first starting meds I feel overwhelmed with all the choices. (We all want what is the best for ourselves, right?). In my opinion going with Sustiva is not a slam dunk, because I suffer from a moderate case Generalized Anxiety Disorder (GAD) which can manifest sometimes into panic attacks (not fun). From what I have read Sustiva can often magnify these symptoms of anxiety which has me looking at alternative options. However I certainly dont want to pass up on the so called Gold Standard Sustiva, but... (Im scared and I dont feel as if I can just put my life on hold while I try to find the right regimen, not to mention I still have to work to support my family and pay the bills). OK, lets say I do try Sustiva and have a bad reaction, once I stop taking Sustiva how long would it take (hours, days etc) before I felt better again? I guess part of my question is if I dont go with Sustiva will I ultimately be short changing myself years of life????? If not maybe the angst of Sustiva is futile.

I asked my Doctor for plan B and he through out:

1) (Epzicom + Reyataz) He said since my VL is relatively low I would not need the Norvir boost. 2) (Reyataz + Truvada + Novir) 3) (Viramune + Truvada)

What are your thoughts about Sustiva alternatives mentioned above? Or is there an option not mentioned that I should be seriously considering? I know I rambled a bit, but I have a lot of thoughts and would value your opinion

PS I tried Lexapro and Prozac for my anxiety, but I never got past a couple of weeks before stopping. Both meds made be feel depressed and blue. I never saw any benefit, even though I know results from these meds dont always appear until a month of more.

Thanks for your invaluable service! I will eagerly await your feedback.

Warm Regards,

Response from Dr. Pierone

Hello, and thanks for posting.

If you do start a Sustiva-based regimen and have problems with side effects and need to stop, the adverse effects usually resolve within days.

In terms of plan B if Sustiva does not work out, all of the options you listed are reasonable approaches. Once could make an argument to go with Viramune/Truvada and save the protease inhibitors for a potential future regimen. But if the toxicity was Sustiva-related rash, then switching to Viramune would not be advisable.

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

Technical Competence...
Stocrin Hypersensitivity and Nevirpine

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