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Which first line treatment?
Jun 12, 2008

Hi

I am a 26 year old female who has had HIV for 2 years(UK). Ive had varying cd4, VL and cd4 %. My most recent being 253, 3001 and 20%. I am now planning to start treatment in early July when I have blood test back to determine whether to take kivexa or truvada. My main question is what is the best to take with either of he combinations? (I have no resistance to any drugs yet and am experiencing no symptoms). My doctor is suggesting atazanavir and ritonavir. Does this sound like a suitable treatment? I was hoping to take efavirenz but because I have had e depression once they are ruling it out. Does this seem right? would nevirapine be a suitable drug instead? I am a bit hesitant to take ritinavir to begin with. What would you suggest?

Also as my HIV has progressed quite fast, does this have any indication to how well i will respond to meds?

Thank you Freya

Response from Dr. DeJesus

Hi Freya:

If you have no resistance to anti-HIV medications, you should be able to take pretty much any medication. A past history of depression is not a contraindication to start efavirenz. Many patients with past depression are able to take an efavirenz containing regimen and tolerate it very well. So, you can discuss still this option with your provider, and if you start to notice any recurrence of depressive symptoms, your doctor can always change the efavirenz to something else later (like atazanavir). On the other hand, efavirenz is not indicated if you are in a situation in which you can get pregnant, so maybe this is the real reason why your doctor may not want to consider this treatment for you.

Atazanavir/ritonavir is also an excellent option, either combined with Kivexa or Truvada, especially if you were already found not to have a contraindication for Kivexa. Both treatments are OK, so you should not worry much about them, just start soon, because your numbers are getting to be too low. Good luck!



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