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Responsable Meds and Checkups
Jul 12, 2013

Dear Dr. Ben

Thanks a lot for the previouse response to the choice on starting medication for the first time. It was REALLY reasuring information. Here in Peru there is no truvada but you're alowed to import it only for personal use. That's what I'm doing now. the question:

-How soon does the treatment start taking effect? (-->how soon is it worth to do another round of labs after starting meds for the first time?)

-after the first post-treatment labwork checkup, how offten would be the IDEAL timeframe for regular VL and CD4 counts? other labs to check on kiddney/liver/cholesterol?

last but not least...

- I'll have to move countrys next year as I'm starting a residency (saddly not in infectious medicine) and will then probabbly only be able to do VL and CD4 once a year for 3 years(when I come back home) is it dangerous to only check labs once a year?

-there is truvada available where I'm going but no stocrin. They have CIPLA-Efavirenz there, do you know that manufacturer? is it trustworthy?

(on the CIPLA webpage I found another product "ODIMUNE" that has a composition similar to Atripla, is it a viable/TRUSTWORTHY alternative? (could be a lot cheaper for a lot of people)

http://www.ciplamedpro.co.za/product-catalog/scheduled- products/arvs/odimune-tablets/

Thank you very much for your time and pacience, reassurence from expert guidance like yours makes all this a lot easyer to bear.

Bruno, 25

Response from Dr. Young

Saludos Bruno and thanks for posting from Peru.

1) Treatments work quite quickly-- though the answer depends on what aspect of work you're asking about. Viral loads should drop to undetectable levels in a matter of a few months; CD4 cell counts will rise between 100-250 cells in the first year (and generally continue upwards afterwards).

2) In the first year of treatment, I generally recommend getting quarterly clinic visits (more frequently if you're ill or have a very low CD4 cell count). Here in the US, we'd obtain a VL and CD4 count test at each of these visits. Later, if adherence is established, VL undetectable and CD4 count reproducibly above 350, we can decrease the frequency of laboratory monitoring- to even once annually.

3) See #2.

3b) You can still do HIV medicine even if one is not infectious disease trained.

4) Cipla is a well recognized generic drug manufacturer from India. I'd have no significant concerns about the Cipla product.

Stay in touch.

Abrazos, BY



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