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Reyataz vs Viramune

Jun 3, 2007

I tested positive in November 2006 and guess I was exposed in August 2006. I have had 3 blood tests between Dec and March - viral loads of 360,000, 550,000 and 710,000 and CD4 counts of 260, 340, and 280. My HIV doctor recommends I start treatment and originally suggested Reyataz, Norvir and Truvada or Atripla. I liked what I've heard about Atripla except having to take it at bedtime on an empty stomach. I have a strong family history of heart disease, somewhat high LDL and low HDL and am on 10 mg lipitor. I am concerned about the possible affects Norvir and Reyataz will have on lipids/heart disease/body composition. I would like to know what would be thought to be the prefered treatment for someone like me. I'd also like to know if Viramune would be a good alternative and why it isn't listed as part of a prefered regiment.

Response from Dr. Pierone

Hello and thanks for posting.

For someone with the family history of heart disease and lipid issues it would be preferable to avoid protease inhibitors if possible.

So the choice is between Atripla (which contains Viread, Emtriva, and Sustiva) and Truvada and Viramune. Viramune generally leads to a better lipid profile than Sustiva. But the reason that Viramune is not on the preferred regimen list is because of the low, but real, risk of liver toxicity. The main period of risk of Viramune-associated liver toxicity is during the first several months of therapy. Once someone gets past this initial timeline, then it is a very well tolerated medication. The risk of Viramune-associated liver toxicity is greater in women with greater than 250 CD4 cells and in men with greater than 450 CD4 cells. So, if you are a woman, then starting Viramune at this level would be somewhat risky, but if you are a man it would be a reasonable approach.

I hope that this information helps and best of luck to you!

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