I've had HIV for less than 18 months. CD4 = 409 (a slow decrease from 520 since the first test in January 2003). Viral load is 109,000 and has hovered around 100,000 copies since the first test. I've decided I want to start treatment and have an appointment this week. A few months ago Combivir + Sustiva or TDF + 3TC + Sustiva were suggested as most likely first treatment options. Someone recently suggested Keletra might be a good alternative to Sustiva as it brings down viral load more quickly, and doesn't stay in the blood as long as Sustiva. He also found the need to go urgently was a preferable side effect to possible mood, sleep or psychological disturbances. What do you see as the pros and cons of Keletra vs Sustiva, and also of AZT versus TDF?

Kaletra and Sustiva based regimens are currently among the favorite combinations for good reason. Each drug has its pros and cons. I personally favor starting with a Kaletra based regimen in order to avoid quick development of resistance. Once the patient in doing well I often switch to a simpler regimen (could be once a day and Sustiva is an option). I often use Kaletra with TDF and Combivir (AZT + 3TC) for initial therapy and then simplify. I use both AZT and TDF often. Both are good fits with 3TC or FTC. TDF has the advantage of once a day dosing is a common choice when the regimen can be safely simplified. KH