Question:
My friend HIV+ for 7 yrs was recently started on AZT/3TC while waiting for the results of viral loads. His Tcell count was
188 before meds. He was antiretroviral naive before this with no OIs. He has some treatment decisions to make and I was
wondering if any of the information avail at the conference would assist us. Certainly the viral load results will have a
bearing on decisions but these are the choices we have come up with: 1. If the viral load responds to the AZT/3TC
combo, stay with that and do not add a PI until absolutely needed. 2. Start immediately on the Ritinovir/Saquinavir combo
(He is not structured enough to follow the Crix. requirements and dosing schedule). 3. Keep on the AZT/3TC until the new
PI 'Viracept?' is available and then start that to reduce cross resistence problems noted with the other PIs. Perhaps info
from the conference would provide some other treatment choices. Any information that you could share with us would be
greatly appreciated.
Dr. Torres' Response:
In general the choice of the initial regimen should be based mostly on the
level of HIV RNA, if the viral load is less than 10,000 it is generally
recommended that he start with tow nucleoside analogues; if > 10,000 to also
start with a protease inhibitor or nevirapine as a third drug. In regards to
which protease inhibitor there are data that support starting with
nelfinavir, since it seems to induce much less cross-resistance.
Ramon Torres, MD
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