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PI vs. NNRTI as First Therapy JB
Nov 27, 2000

I was recently diagnosed with a viral load of 50,000 and a T Cell count of 250. My doc has recommended that I start a combination therapy next month (after my second test results come back) and said I could either go with 2 NRTIs + 1 Protease Inhibitor, or "spare" the Protease Inhibitor family by starting with 2 NRTIs + 1 NNRTI such as Sustiva. I believe I read somewhere that Sustiva performs just as well as the Protease Inhibitors in reducing viral load. Based on my numbers, would you lean one way or the other? Thanks!

Response from Dr. Bartlett

The good news is that you have outstanding options, and either approach should work quite well. When trials have directly compared the PI and NNRTI approaches, it appears that NNRTI-containing regimens perform at least as well. NNRTI-containing regimens also require fewer pills and may be simpler to take. On the other hand, no one knows if you should use NNRTI's up front in the initial regimen or save them for later. So, in either case, you should do very well.

John A. Bartlett, M.D.

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