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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!



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