Hi, I'm ready to start meds for first time and my Dr. has recommended two options for me. Truvada+Kaletra or Truvada+Viramune. I would like the option that has the least side effects and least toxic. I'm a little concerned with the possible psychological and liver side effects of Viramune is that warranted? What do you recommend? Thanks.

Both of those regimens are very effective in treating HIV, but the side effects profiles are quite different.

Kaletra has been associated more with gastrointestinal side effects, such a change in bowel movements, and alterations on your lipids, such as cholesterol and triglycerides.

Viramune on the other hand has been associated with an allergic rash, which tends to occur in some patients in the first 1-2 weeks of treatment, and with liver abnormalities in also a small percentage of patients. This liver toxicity is highly dependent on your CD4 count, and tends to occur with an increased frequency if your CD4 count is > 400 cells when you start treatment with Viramune.

There are minimal, if any psychological adverse effects related to treatment with these agents. Keep in mind that these adverse effects do not occur in every patient.

If your CD4 are lower than 400 cells, and you are very concerned about adverse effects from the medications, starting Viramune and Truvada, with a close follow up after initiation of therapy may be a good option for you. But either of these regimens are going to be fairly safe and well tolerated. Good luck!