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the new gold standard? Apr 29, 2001 I'll be starting treatment in a few months time I suspect. According to my research it seems that the most potent drug regimen with the fewest side effects (for Mr. Average) is Epivir, Abacivir and Efavirenz. I know that treatment must be individualised but do you agree that for most people this is the new 'optimal first line therapy/" All the best C |
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 C I don't buy the idea there is a gold standard or that we can call any combination "optimal." That sounds like marketing hype to me (you are not a drug rep, are you?). One size does not fit all (or as my colleague Kristin Ries says: "one size fits one") Don't get me wrong. Lamivudine (Epivir), abacavir (Ziagen)and efavirenz (Sustiva) is a very potent, compact and well tolerated regimen. Using abacavir with epivir early on makes excellent sense from a resistance persective. It might be a great choice for many folks. It might be a great choice for you, if it was suggested to you. I could go through possible disadvantages for any first line regimen, however, and these keep me from touting any one recipe. For example, the regimen you chose has problems that might rule it out for some people. The CNS side effects of Sustiva may rule it out for pilots, heavy equipment operators and the like. People with histories of significant psychiatric disorders need to be careful with it. Ziagen should not be used by anyone without the ability to contact their doctor during the first few weeks in case they have symptoms that could be hypersensitivity. However, I could point out limitations for combivir/nelfinavir, Triziivir, D4T/3TC/nevirapine, or a Kaletra or amprenavir-based regimen. It really is a matter of understanding the pluses and minuses as they relate to each person, and then involving them in the choice. I hope that doesn't sound dogmatic or defensive, but it really is important to individualize. If you talk to most people with a lot of HIV experience and look at what they actually prescribe, you'll find a lot of different first line regimens, depending on what the patient wants and needs. Regards ATP | ||
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