Hello, I have been positive for 3 years, did regular cd4 count test and last was 375 and my doctor wants me to start treatment. Truvada is not available in my country so my doctor told me it is best to start with stocrin/kivexa but unfortunately HLA-B*5701 test is not available in my country. He told me that even if HLA-B*5701 test is negative it is necessary to monitor and avoid HSR reaction, so he suggested starting treatment and be careful. The alternative option is to start with videx/epivir/stocrin but my doctor told me the previous regimen is much better. I am really confused and don`t know what to do... To start with risk of HSR or to choose videx/epivir/stocrin. When HSR reaction does usually come up? I mean how long after starting treatment? How long is the period after I can finally relax after starting treatment. I read that even life-threatening adverse effects are possible. Does it happen gradually or suddenly, meaning can somebody just die after starting treatment with abacavir or it happens gradually? I am suposed to take this treatment at bedtime and wouldn`t like not to wake up... Sorry to write too long but I am really worried. I live in East Europe and I could go to Austria (the closest country where test is available) but it is a hard financial issue to me, and my doctor (who has been working with hiv positive patients for more than 12 years)told me it is waste of money since I lost job recently, and monitoring is necessary anyway. Your opinion would help me a lot, thank you very much in advance.

I prescribed a fair amount of abacavir in the pre-HLA B5701 testing era. The vase majority (>>90%) of patients did fine. Having open channels of communication (access via phone or clinic to be seen if a concern arises) is key. I would still use abacavir if unable to get HLA B5701 testing but would make sure patient can be seen if a rash and other possible HSR symptoms develop (most important during first month of treatment-esp first 1-2 weeks). If such symptoms develop then would switch off the abacavir earlier rather than later--that approach worked fine when mixed with a healthy dose of caution and common sense. KH