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HIV+ with COPD
Nov 13, 2000

For an HIV+ person that has been diagnosed with COPD, and haven't been put on any HIV meds as of yet, what might a good choice of HIV meds to take, without including a PI?

Thank you. Seeker of support.

Response from Dr. Pavia

Good question. You may already know this, but others may not, so I will mention that there is good evidence that COPD progresses more rapidly in HIV infected folks (that stands for Chronic Obstructive Pulmonary Disease, aka emphysema and chronic bronchitis). These are really important reasons to quit sm)oking, or at least cut way down now and quit later.

Now that I've had a chance to make that pitch, COPD should not significantly effect the choice of initial therapy, unless you are on specific other medicines. There may be some interactions between Sustiva (efavirenz) and Viramune (nevirapine) and theophyline or prednisone, but these are minor. If you want to avoid protease inhibitors (which is a matter of choice) your choices boil down to an abacavir-based (Ziagen) regimen or a non-nucleoside based regimen. Among the non nukes, both Viramune and Sustiva are good drugs, each with some pluses and minuses, which we have gone over before. Ziagen based regimens usually use it with Combivir (AZT and 3TC) which makes it a 2 pill twice a day regimen. Another approach is to use D4T, 3TC and abacavir, which may avoid some of the AZT associated nausea. An all in one pill of Abacavir, AZT, 3TC, to be called trizivir is coming out sometime "soon".

Both of these approaches have the problem of what happens if you fail the regimen (usually because of missing doses!!). In the case of abacavir regimens, you initially get 3TC resistance if you fail but eventually get resistance that includes AZT and d4T. If you fail on a non nuke-based regimen you will develop resistance to the whole class of non nukes. I usually don't recommend abacavir based regimens for anyone with a viral load over 100,000 based on one large study, but that remains somewhat controversial. Below that level both types of regimens should do well. Learn about side effects and take your choice.

Good luck

ATP

Andrew T. Pavia, M.D.



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