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This combo?
Jan 5, 2003

Hi, this is a great forum for learning more, thanks!

I've been positive for over 10 years and it's time to start meds...(CD4 256/16, VL 158,967).

My doctor has recommended Combivir & Kaletra as a good starting regimen.

Question: I don't ever see these mentioned, is this a good regimen? And, why has he recommmended a PI and a Nuc, instead of a Non-Nuc.

This is a big step and I just want to have as much info as possible...thanks much!

Ric

Response from Dr. Young

Ric, thanks for your question.

The combination of Combivir and Kaletra is a well studied initial option for the treatment of HIV. Two large, long-term studies, named Abbott 720 and 863 have looked at the combination and have shown excellent potency and durability.

You've probably heard less about initial protease inhibitor therapy in large part, because of the difficulties and limitations of the first generation protease inhibitors- namely large pill counts and side effects. Kaletra represents a lower pill count way to administer PIs- though it's side effect profile still has some gastrointestinal issues.

The real question boils down to the differences between PI-based therapies and non-nuke-based regimens; the later typically has improved side effects and very low pill counts. Indeed, efavirenz (Sustiva) is the only single agent of the two groups that is FDA approved to be given once daily-- hence it's basis of the construction of once-daily regimens.

Which one to use? PIs clearly have a long track record with potency;boosted PIs are especially interesting in their increase in potency and may prevent the emergence of resistance. Their downsides (other than discussed above) are increases in cholesterol and the possible link to heart disease and stroke.

Non-nukes (most data is about efavirenz) have been shown in multiple studies to be superior to single PI regimens in persons with both intermediate and advanced HIV disease, are probably better tolerated than PIs and have fewer pills, though the entire class of medications can be wiped out by single mutations in the virus. The class of medications has been very useful in salvage therapy for persons with prior PI resistance. Hence, the timing of their use is very important.

In the end, the choice is dictated by personal preference and treater experiences. A detailed discussion with your doctor about your options would certainly be a good idea before initiation of treatment. Remember, though that even once you've started on treatment, that if you find that there are aspects of your current therapy that don't work for you, your regimen is not cast in stone-- you can change what you take to accomidate your side effects or for convenience sake.

Good luck, BY



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