Hi Dr., A friend of mine has a CD4 count of 300 and VL of 50,000 and is a flight attendant. He has chosen to start HIV drug therapy. Since he will be on the plane and tending to many people in different time zones, what drug medications or combination therapies do you suggest? I know that many of the antiretroviral medications cause nausea and diarrhea, but is there a combination of drugs has lesser side effects for a treatment naive person who is in the air most of the time?

thank you for your time.

Excellent question. My usual approach to recommending a starting regimen assumes access to a restroom and perhaps some flexibility in the schedule during the first 1-2 weeks. It is often advisable to start meds during at least a brief (2-3 days at least) interlude from work. Regimens based on NNRTIs (Sustiva or Viramune) along with 2 NRTIs (such as AZT + 3TC= Combivir) are among the easiest to start and tolerate. Viread or FTC are also options for the NRTIs. Sustiva can through off sleeping patterns and cause some CNS problems while Viramune may have more severe rashes/liver problems so an understanding of the schedule and duties as well as past medical history is important before making a recommendation. KH