Hi,

Greetings from Canada. My CD4 count hovers around 250 and my VL is 35,000. My doctor has informed me that I should start thinking about medication. He suggests that I start with the once daily Truvada + Sustiva. The government sponsored drug programme here, however, does not cover Truvada. My doctor suggests that I go on Kivexa + Sustiva since it is covered by the government, and that a genetic test can determine whether I will develop Hypersensitivity Reaction.

I am wrestling with whether I should pay for the Truvada out of my own pocket since my doctor claims it is a superior drug (because of it's long half life.

Thank you very much for your good work!

My own personal preference is to not start on too many drugs that have some overlapping toxicities at once if there are other options available (for example abacavir and efavirenz are good drugs together but both can cause early rashes and it can be confusing to sort that out). Checking for genetic sensitivity to abavavir can significantly decrease the odds that a reaction would occur (low rate in persons who are HLA B5701 negative). Canada has been a leader in efforts to use that test to identify patients who can even more safely use abacavir. I generally start patients on a boosted PI regimen and then once suppressed and if no baseline resistance switch to the simplist and most affordable combination available to the patient that the patient can well tolerate (that ultimately might include Sustiva. KH