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starting treatment in half
Apr 16, 2001

I was infected only 3 months ago, I am staring retrovir(zidovudina)+epivir(lamiduvine) treatment. I am thinking on taking 1 dose a day instead of two (half recomended dosee) Is these better than nothing? I heard they are doing trial test with these kinds of dosages , do you have any feedback.

thank you, I apreciate your time to answer

Response from Dr. Cohen

Well - what you describe makes little sense...

If you are HIV+ and early on in the actual infection (which is very different than 3 months after first testing positive - you sound like you know when you actually were first infected?) - then if you treat at all - you should treat with something effective at stopping HIV from growing. The use of just 2 nucleoside antivirals like zidovudine (also called AZT) and epivir (3TC) will just not be potent enough for very long - indeed, from all of the studies that used this combo - we can see resistance to the 3TC develop in about 2 weeks time. And then this medication is no longer fully potent for you. And while there can still be some effect from these two meds - it is rarely enough to truly stop HIV from growing. You'll be tapping the brakes to slow the car, but you won't stop it. And sadly, once these resistance mutations happen in HIV - odds are good they are always with you. And so 3TC will never be fully potent from that point on. And it is a great drug to have available to you when it is fully potent - as it is one of the easier drugs to include in a regimen. As for taking half dose - unless you are half sized - this will likely lead to even less benefit from these meds. While you might be able to decrease the total dose of the AZT from the standard 300 mg twice a day to say 200 mg twice a day - it just doesn't last long enough in the cells to rely on it when you take it once a day as far as we know. 3TC might be OK for once a day use - but only if you take the full dose. Otherwise there won't be enough medication there to do the job.

We have developed enthusiasm for treatment in the first few months after infection - it appears that when effective treatment is started and we stop HIV from growing - we might save a population of your immune cells that might one day in the future allow you to control HIV even without medication some day. But the key to getting that result is to stop HIV from growing - your combo, and especially your dose reduction - won't get you that result. And will likely leave you with more resistance to meds...

Perhaps the trial you have read about involves using these two meds for PREVENTION of HIV infection in someone exposed but not infected?? In the case of someone who was exposed but tests negative - these two meds are used. And since we are not sure how long we need to treat, perhaps you read that half the standard four weeks of treatment was being considered somewhere - two weeks??

Other than this, I cannot imagine any good reason why any research would suggest half doses of these meds. Too much to risk I think...

Hope that clarifies.



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