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first PI based and then switch to NNRTI?

Jul 2, 2004

Helo doc, I was infected one year ago and my VL has been consistently very high (150k) after innumerable tests. CD4 count is now down to 350 and doc wants me to start next month after a last test. He wants me to start on Kaletra and Combivir. I have reduced susceptibility from infection to most PIs (except kaletra: mutations at 82 and 90 among other secondary PI mutations but no RT mutations). He says that he wants to bring my VL down as fast as possible and after a couple of months switch me to Sustiva, but from what i have been reading, Sustiva and combivir is a good first regimen even with high VLs. Given my situation, would it not be better for me to start with an NNRTI rather than a PI? If i do follow his advice, could i ask to be put on Viread and FTC rather than combivir? Are those two NRTIs compatible with both kaletra and sustiva? Thank you very much. Desperate!

Response from Dr. Pierone

Yes, your idea makes more sense. The pairing of Combivir and Kaletra is certainly potent, but comes with more side effects than a Sustiva-based regimen. Viread and Emtriva (FTC) have fewer side effects than Combivir and this would allow you to take a once daily regimen. This would allow you to save Kaletra in case this regimen does not agree with you. A would offer a word of caution though. Since you are starting treatment with transmitted resistance to PIs it is critical that you stay fully adherent with therapy and not develop resistance to the NNRTIs. Good luck!

Viral blips
Avoid Ziagen if VL > 100,000

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