Dear Dr

I am male (25) CD4 450 and VL is 60000. No drug resistance, no IV drug injection and no others disease

1. how good is the new approved once a day regime "Sustiva plus either Truvada (Viread + Emtriva) or Epzicom (Ziagen + Epivir)

I have PPD positive skin test (not active TB ). Can I still take above combination and what else do I have to take for the TB?

2.if I take 100% of my medications is there still risk of developing drug resistance if so what is the chance of it ?

3.If I got resistant or my first line therapy is failed how many other regims are avilable for a hiv + person can try on ?

4.What is your corrent favourit regime for someone who is on his first line treatment ?

thank you very much !

Tom

I like really simple treatments and my favorite is low pill count once a day, however you do this. The Truvada/Sustiva combination is highly effective. We have long-term data on this (using 3TC rather than FTC) to show that it is both safe and effective. I would expect Epzicom to be as good (unless there is an abacavir hypersensitivity reaction) although there is less hard data on this. If you need to take some sort of treatment for your TB, it may well be only a single drug (INH) which would not affect your HAART regimen in any way, except that the INH could be a bit hard on your liver, so you will have to watch. If you had to take rifampin for the TB, this could be a problem as it would reduce the efficacy of the Sustiva and you may have to increase the Sustiva dose or try another treatment.

Finally, if you are 100% adherent, there is little or no chance of developing drug resistance that is clinically significant, unless it was there all along and the HAART allowed for the pre-existing resistant mutants to grow out quickly. This is why we recommend that you watch your viral load closely in the 1-2 months after starting HAART. If it's not going down adequately, we do a resistance test to see where we are. And if you did, at some point, have a virologic breakthrough, there are many choices for an effective (and still simple) second line therapy. Things are a little less certain for third line therapy, but I am an optimist, my friend...