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Starting regimen

Dec 9, 2004

What is the usual strarting regimen for someone with a viral load of 100,000 copies/ml; CD4 count 190 and HIV genotype consistent with "wild type"?

Response from Dr. Frascino


There is not a "usual" starting regimen, because there are many factors that must be considered in choosing the optimum regimen for any individual.

I'd suggest you review the information in the "Starting Treatment" expert forum. Within the past few years it has become clear that not all antiretroviral regimens are equivalent in potency or toxicity. Initial regimens must be individualized and the choice is dependent on multiple factors, including (1) other health problems; for instance, hepatitis C, (2) readiness to start and adhere to therapy, (3) concomitant medications and (4) viral resistance to certain medications. Often a regimen containing a non-nucleoside is chosen for an initial HAART regimen when adherence is expected to be good, because of convenience, well documented virological suppression, lower rates of toxicity and fewer drug-drug interactions. However, when it comes to selecting an antiretroviral regimen, the mantra should always be "one size fits one!" You should discuss all your options with your HIV specialist, weighing the pros and cons, and factoring in your personal situation. One other point to mention: since your CD4 count is below 200, you are at risk for opportunistic infections, especially PCP (Pneumocystis carinii pneumonia). You should be started on PCP prophylaxis immediately.

Good luck!

Dr. Bob

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