My CD4 is 390 and VL 33.000 I think Ill soon have to begin medication. Can someone begin only with Truvada? Does taking Truvada alone makes undetectable viral load? Or must begin with Atripla? (Im afraid of Efavirenz side effects).

Hello,

You're probably correct that you'll need to start treatment in the near future (this assumes that your asymptomatic; if your already experiencing symptoms, then CD4 count becomes less relevant).

One should definitely, positively not start HIV treatment with just two medications (such as are in Truvada). Atripla (as the name suggests) is a three drug combination that includes the two in Truvada and adds efavirenz.

If you're reluctant to use efavirenz, don't fret. There are quite a number of alternatives (with Truvada or Epzicom), including well tolerated boosted protease inhibitors and the alternative NNRTI, nevirapine (Viramune). We have also started some patients on the new (not yet FDA-approved for first-line) integrase inhibitor, raltegravir (Isentress).

So, definitely not Truvada alone, but Truvada (or Epzicom) with any of the alternative so-called third drugs should make for a well tolerated, and effective HIV treatment regimen.

Be well, BY