Truvada and Nevirapine (Viramune) - the right choice?

[loneranger]

Hi All

I started treatment in March this year. My doc recommended Truvada/Nevirapine as my first line therapy as oppose to Atripla. This was mainly due to my above average risk of developing heart problems and also because I wanted to avoid the reported central nervous system side effects on atripla.

After 2 weeks on meds my viral load had dropped from 75000 to 1450. I had a blood test taken at 4 weeks in and my cd4 had risen from 236 to 450. My latest lab results were taken at the beginning of June, viral load was down to 147, no cd4 test was done. My doctor said that although my results were good, he has seen a quicker or better result on this combination (I assume he means quicker decline in viral load to undetectable and higher gain in cd4 cell count). He is expecting me to be undetectable by September. I guess my concern is two-fold - am I on the optimum combination for first line treatment? And is my rise in cd4 counts and drop in viral load typical or slower than average?

I should add that I have had no major side effects from the meds, apart from a horrible sore in my mouth which appeared a week after starting and has eventually disappeared just a few weeks ago. I am also feeling really well and much better than this time last year!!!

[newt]

This is a good result

Docs (rightly) worry about viral load going below 50 in 6 months but I wouldn't fret too much as long as the measurement is within striking distance of 100 (in general, it's the trend that counts and viral load test results can vary). It can take longer then 6 months to go undetectable sometimes. Your CD4 climb is good, practically back to normal. This is a good start.

- matt

[loneranger]

Thanks Matt

Good to have some reassurance! 

[risred1]

My doctor stated that everyone is different and expectations that every "MUST" be undetectable in a short period of is less of a concern.

As long as your progressing, it may take 3-6 months, maybe even more to achieve that goal.

As to optimal, that is a bit relative, but the recommended guidelines for treatment naive folks are the guidelines for a reason. Going off the script/guideline may depend on resistance profile of your HIV.