Hi Dr. henry... thanks for your helpful answers. I was under the impression that sustiva/truvada was a very well regarded option for first line treatment, but you mentioned mitochondrial toxicity as a possible side effect. How common is this and how soon? I have achieved great control on this regimen after 6 months with no noticeable side effects. What do you tend to prescribe as a first line? (or in my case, as a replacement.) and what are the side effects?

The rate at which components of the lipodystrophy syndrome develop on some of the newer NRTI combinations (FTC/tenofovir and 3TC/abacavir) seems to be slower that with AZT or D4T combinations (usually with 3TC). Long-term data and independent studies (not direcntly drug company supported) are needed to sort out what we can expext and how the newer combinations compare to each other. I tend to start patients with a boosted PI regimen until undetectable (to avoid initial resistance problems)and then switch to an indiviualized maintenance regimen (wide range of possibilities). KH