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Meds for starters
May 4, 2008

I was diagnosed last year at which time my CD4 count was 360 cells and my viral load was 10,000. I just received new results: CD4 290 and viral load 50,000. I discussed with my doctor to start medications. He suggested starting Lexiva and Truvada. Should I start medications or should I wait a little bit longer? Is this good prescription to start? I would like to understand more about how the decision of what dedications to start with should be made?

Response from Dr. DeJesus

Your doctor is right about the benefits of staring medications at this point. There are multiple studies that irrefutably have proven beyond any doubt the benefits of treatment initiation when CD4 cells decline below 350. But there is nothing magic about that "350" number, and some providers -- myself included, would argue that you should consider initiation of treatment even at a higher CD4 count. So if your CD4 count is 290, I strongly recommend you to prepare to start medications. It is never an emergency, but the lower you let the CD4 count go, the more difficult are for them to come up, in addition that you could potentially avoid many other future problems by starting a this point. But this is a decision that you need to make, and feel comfortable, because eventually, you are going to be the one taking the meds, and if you are not mentally and psychologically ready, you are at risk to take the treatment wrong. But I will reassure you that this is definitively the right decision.

The treatment with Truvada is OK, but I am not too crazy about the selection of Lexiva (a protease inhibitor) without ritonavir (Norvir). For patients initiating HIV therapy the guidelines recommend that if a protease inhibitor is going to be used, to combine it with Norvir. By combining the Lexiva with Norvir the protease inhibitor becomes more potent and effective. This also has been proven without doubt by many clinical studies. By combining the Lexiva with Nornir, the dose of Lexiva will also decrease, and you may be able to take your regimen once a day, instead of twice a day if you take the Lexiva without Norvir. So I will advise you to ask your provider to consider then Lexiva 700mg (2 tabs), Norvir (1 capsule) and one Truvada, once a day. Good luck!



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