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thinking about starting medication
Nov 14, 2012

i've had the HIv diagnosis for about 4 years. i have not started taking meds, my CD4 count is 500 and viral load 65,000. I have not been ill at all although my tonsils have been swollen for a while. I'm thinking of starting medicines and not sure which medication is best to start on, with minimum side effects.

Response from Dr. McGowan

Hi,

As you may know, the field has moved toward earlier treatment of HIV as we have accumulating evidence that suppressing the virus may help prevent damage to the blood vessels, heart, kidneys and brain due to the imbalance in the immune system caused by the virus. These effects can occur even with high CD4 cell counts.

First you need to know what the resistance pattern of your virus is. This done by a blood test called a genotype...even if you had this test when you were first diagnosed it best to have it checked again in case you may have been exposed to a new strain of HIV during the past 4 years.

If there is no resistance in your virus, then you have many choices. There are 4-6 "preferred" treatments based on the DHHS and IAS Treatment guidelines. These are generally safe and well tolerated with good long term data.

These include:

Atripla Truvada + Norvir + Reyataz Truvada + Norvir + Prezista (once daily) Truvada + Isentress Epzicom + Norvir + Reyataz Epzicom + Sustiva

The choice of which would be best for you would depend on a few factors:

Do you plan to become pregnant (not sure of your gender)?--We would avoid Atripla or Sustiva if you may become pregnant.

Do you have any kidney problems? --We may avoid Truvada (tenofovir) in some forms of kidney problems.

How high is your viral load? -- We may want to avoid Epzicom (abacavir) if your viral load is higher than 100,000

Are you taking any other medications? --There can be drug interaction between our meds and other medications.

Do you use antacids? --these may effect Reyataz absorption

Do you have an erratic travel schedule? --you may have problems being adherent with Atripla which should be taken at bedtime

Do you have depression? or high cholesterol? or hepatitis B or C? All of these may effect our choice of therapy.

There are also a couple of new treatments, Complera and Stribild, which are single table once-daily regimens that may be good options for certain individuals but are too new to be on the "preferred" list.

So there are lots of possible options and the combo needs to be individualized to you. Talk to your medical provider and discuss your preferences and review all of your medical history and life schedule and he/she will work with you to pick out the best combo.

Best to you,

Joe



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