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Meds in Serbia
Jul 21, 2009

I am writing to ask you about options to start ARV treatment here in Serbia. Unfortunately there are not registered some of the new medicines. Here we don`t have access to Atripla and Truvada. :( Here is the list of all drugs which are available and registered here:

NRTI: 1) Retrovir 2) Videx 3) Zerit 4) Epivir 5) Ziagen 6) Trizivir 7) Combivir 8) Kivexa

NNRTI: 1) Efavirenz 2) Nevirapine

PI: 1) Kaletra 2) Invirase 3) Crixivan 4) Norvir 5) Viracept 6) Fosamprenavir

EI: 1) Fuzeon

Here people usually start regimen with some of this options: 1) Combivir, Efavirenz 2) Efavirenz (or Niverapine), Videx, Epivir (this option is very often) 3) Efavirenz (or Niverapine), Videx, Ziagen 4) Keltra, Videx, Ziagen

What do you think about these options? Is there any other regimen which would you recommend for a start from this list of 17 medicines? My last cd4 tells were last time 390 and here treatment usually starts when cd4 cells are around 300 (actually between 300 and 350, when patients are ready). There is monitoring of cd4 count every 3 months (without pcr and %, pcr and % are checked just for the people who are on treatment) I know I have asked too many questions but I do hope you will have enough time to answer my questions. Thanks very much! Best regards from Serbia

Response from Dr. McGowan

There are a fair number of good possible combinations on the list. Kivexa is the same as Epzicom in the US. For someone initiating treatment for the first time (as long as you have not acquired a drug resistant virus) you should have an excellent chance of achieving full suppression of the virus. The key is to be on a combo of 3 active drugs and not to miss the doses.

Best, Joe



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