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Questions about my first line treatment regime
Jul 28, 2011

I'm am due to start treatment in a couple of weeks and I am trying to decide which options to go for. I am in the UK so the drugs available to me on the NHS are limited. I have suffered depression and severe anxiety in the past, so I have raised my concern with my Dr about taking a combination incl Efaverenz (Sustiva).

The only other options I have are: Kivexa + Atazanavir + Ritonavir or Truvada + Atazanavir + Ritonavir It is also possible to change Atazanavir for Darunavir (Prezista) in both the above combinations.

I work as a model so I am concerned about taking any drugs that are likely to make me gain weight or have a higher risk of lipoatrophy as obviously this would effect me financially. I also travel frequently and deal with frequent time changes, however obviously my mental health and a successful treatment regime are my main priority. I am 30 yrs old, do not have any other health related issues and I have been monitored since the day of my infection 3 years ago. My CD4 is 386 and my Viral load is 14,000 copies/ml

I have read that Truvada is slightly better than Kivexa and Prestiza is slightly better than Atazanavir

My question is out of these options which would you consider to be my best/successful option taking into consideration my personal circumstances listed above?

Thank you all for such a great website!

Response from Dr. McGowan

Tnanks for your question.

I am glad that you are ready to start meds and, as your question shows, are really thinking ahead about your treatment.

I agree that if you are traveling with frequent time changes and concerend about depression and anxiety an efavirenz regimen may not be your first option. Also there is a chance of developing scleral icterus (yellow color in the white part of your eyes) with atazanavir which may have an effect on you as a model.

Assuming there is no evidence of drug resistence on your genotype than the truvada, ritonavir and Prezista (which could be used once a day) may be best for you. Discuss these issues with your doctor.

Best,

Joe



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