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Starting Meds for the first Time(corrected)
Jul 4, 2013

Thank you for this awesome forum, the question is simple,

I was recently diagnosed (march 2013) (was infected in december 2012) and have never had treatment before. (my VL is 47000 and CD4 580) I wish to start treatment as soon as possible and have been recomended to start with stocrin/truvada (same as atripla but they don't sell that here in Peru) Is it a good Starting combo or should other meds be used to start treatment from scratch? --> thinking of having the option of switching to truvada+stocrin if other drugs don't work? Is it reasonable to want to save them so that I can use them later (so as to not develop resistance to them?) or can they be used as first choice meds? (trying to start on the right foot here.. thinking about long term benefits) My other worry is that Peru beeing an underdeveloped country I'm beeing offered an option of "meds that will do" and not "all the meds that would do better" what would be the best combination for starting? zido-lamivudin + truvada? other/more drugs? I have this horrible feeling, fear really, of commiting a mistake on the very start and reducing my treatment options or efficiency. Thank you a lot Dr. B for your oppinions and suggestions!

Bruno, 24

Response from Dr. Young

Hello and thanks for posting.

While there is a lot of regional differences in the recommendation of when to start medications, this weeks' World Health Organization guidelines now recommend treatment for people with CD4 counts less than 500; the US guidelines advance further and recommend treatment for all people living with HIV who are willing to be adherent to medical plans.

As for your proposed treatment, Truvada + efavirenz (Stocrin, Sustiva) indeed is a very highly recommended (in WHO and US treatment guidelines) first line treatment. It should be used cautiously in people with kidney or bone disease (or significant risks), as the tenofovir part of Truvada can increase the risk of toxicity to either organ system in some individuals.

If Truvada (or it's components, tenofovir and FTC) are not available (as is the case in many locations), then AZT + 3TC (Combivir and other brands) is a suitable alternative- but it's recommended that this be combined, not with Truvada, but with efavirenz.

All of these regimens can be very effective and durable-- the essential thing is to really work to optimize staying adherent to your regimen and medical follow up.

Abrazos, BY



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