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Starting Haart Medications
Sep 9, 2007

I am 50 years old and just tested positive. CD4 was about 300 and viral load was 34,000. Is Reyataz, Norvir and Truvada a good combination to start with. I am concerned with long term health effects on my internal organs and overall effect on me. Would Atripla be a better choice?

Response from Dr. Young

Thank you for your post.

First, I agree with the recommendation to start HIV medications- you have a CD4 count below 350 and there's evidence that persons above age 50 are at greater risk of an HIV event over time than younger patients.

The first principle of choosing HIV treatments is individualized care-- selecting medicines based on the individual characteristics of the virus and the patient.

Both of the treatments that you describe are recommended by the most current treatment guidelines. Both are very well tolerated and should have little risk of toxicity. Atripla (tenofovir/FTC/efavirenz) is well studied and has the lowest pill count of all regimens; the Truavada (tenofovir/FTC), Norvir (ritonavir)/Reyataz (atazanavir) regimen is also low pill count (3 per day) and generally very well tolerated. The primary difference between the two is the choice of NNRTI (efavirenz) or boosted PI (ritonavir/atazanavir)- it's important to establish if your virus has any transmitted drug resistance (more commonly to NNRTIs). After that, the individual characteristics of the two drugs often guide the choice- efavirenz must be taken at bed time and can cause psychological side effects for a brief period; 'taz must be taken with food (though other PIs don't need to be) and antacids must be used with caution. One feature that is important for some patients is the pattern of drug resistance after the rare treatment failure- there is usually more drug resistance after failure of NNRTI regimens than boosted PI regimens- hence, in general, there's more treatment options preserved after PI failure than NNRTI.

The choice of nukes is similarly influenced by a number of factors- in the case of Truvada (or Atripla), it would be important to know if you have pre-existing kidney disease, or risk factors for kidney disease. In their absence, this would be a perfectly good option. If you have kidney risk, then other options recommended by guidelines (abacavir/3TC or AZT/3TC) might be better suited.

So, if you have questions about these options (or others), certainly invest the time to speak to your doctor to find out what regimen is best suited to you and your virus.

Best of health, BY



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