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First line treatment when resistant to Atripla
Dec 30, 2008

Hi doctors! Thanks for all you hard work. Ok..I've been poz for 6 years, not on meds, T cells stay at 350, viral load 10K consistently. Dr. did a genotype test on me for last check up and the one drug I'm resistant to is Sustiva so he said I wouldn't be able to start on Atripla when the time comes. All other drugs tested maximum efficacy and not resistant. With that said...I was totally bummed out about not being able to use the once a day Atripla. Since I'm a virgin to meds I'm a bit confused about what other combos/options I have. Any advice would be greatly appreciated. Thanks again.

Response from Dr. Young

Thanks for your post.

Not having all your treatment options is disappointing, but just because you can't use Atripla (or efavirenz) doesn't mean that you can have a very well tolerated, low pill count, once-daily regimen- it just means that it can't be one pill per day.

You'll likely start on a boosted protease inhibitor regimen with a combo nuke (Truvada or Epzicom). We typically use either fosamprenavir (Lexiva) or atazanavir (Reyataz), but new data and guidelines also now include darunavir (Prezista). The old standard, lopinavir-ritonavir (Kaletra) continues to get used, though I believe that the newer agents offer significant advantages. These options all permit once-daily dosing, with pill counts as low as three per day and no more than 5. They are remarkably well tolerated, arguably as well as the Atripla whose loss you bemoan.

So, don't be so bummed out. In my opinion, the difference between 1 and 3, 4 or 5 shouldn't be the reason that you suffer the much more significant health risks of HIV and AIDS.

Be well, BY



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