Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Treatment Newby...

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ndrew:
Dear Friends,

I plan to start meds. soon, however I am hoping for some advice on treatment options, I am new to this.  I have been reading as much as I can, but still sorting it all out.  With my work load and and stress it is tough as well and I could use the advice and counseling of your experience and knowledge.  I don't have access to a good ID specialist, however my MD is gay and treats a lot of poz dudes and he makes me comfortable and has been spot on in the past.

I will do labs and resistance test in early September and then go from there.  I like the idea on once-a-day dosing, however I don't mind multiple pills.  I have a lot of sleep issues already, so I am concerned about Sustiva.  What are some alternatives for first time treatment...  I am wondering about Viramune (and my Viral 11.5K, CD4 is 292)?

Due to my job (professor), I am concerned about my performance when I start meds., however I am not sure I want to wait until the end of the semester (December) to start.

I would be very grateful for any feedback or advice on meds. for the treatment newby and any experiences as well.

Thanks!
Andrew

newt:
The rule of thumb for first-line treatment is at least 3 drugs from 2 different classes.  There are 3 classes of drugs normally relevant to first-time therapy: nukes, non-nukes and PIs.  A "normal" combo would be two nukes + EITHER a non-nuke OR a (boosted) PI.

Sustiva and Viramune are non-nukes. If you have sleep issues and like a clear head the Sustiva may not be the best choice.  But it is damn effective.  Viramune is also effective. It has a small chance of causing a serious allergic reaction at the beginning, but if you get over this it's a very useful drug. Some docs do use it 1 x day, but really, at least to start, it's best 2 x day. Viramune, though, can be harder on the liver compared to Sustiva.

On the PIs, there are many to choose from.  Kaletra is the grand-daddy (and guideline wise) "preferred" first-time PI.  This can be done once a day if you've never used HIV meds before, but the side-effects (the squits) may be worse and really it's a 2 x day drug. Reyataz is new genuinely 1 x day PI. On the "alternative" list, but still useful, are Lexiva which can be done 1 or 2 x day if you are treatment-naive, and Invirase, which is, still, a 2 x day schedule.  Of these Reyataz is prescribed with the least amount of Norvir booster (100mg a day, the rest use 200mg).  This can be important, since Norvir does cause nausea sometimes, and also is probably responsible for a lot of the lipid problems some people get on PIs.

(Norvir is also a PI but usually used to enhance the effects of other drugs, rather than as a medicine in its own right. It does this by making the concentration of the PI it's boosting more even, so the lowest drug level higher and therefore the chance of resistance is lower.)

On the nukes, there are three main pairs that are common: AZT+3TC, Viread+FTC and Ziagen+3TC.  All of these pairs come in handy one pill formulations.  Viread+FTC and Ziagen+3TC can be done once a day. Many docs will avoid AZT now because of the long-term side-effects (not to mention nausea, which is common) but it still works.

So you have a lot of choice if you want to put together a once-a-day combo.

If your viral load is very, very high, strength may be an important consideration, and your doc may suggest some drugs in preference to others for this reason, and perhaps even a super bombing non-nuke + PI based combo (to start).

This list is not exhaustive.  There are several more options, but they're probably unnecessary to discuss.

A resistance test may be helpful before starting treatment.

i-Base treatment guides

AIDSMEDS: The Big Treatment Questions

- matt

ndrew:
Thank you Matt sir, I think I am finally understanding the complexity generated by all the combinations and names... and will continue to sort this all out so I am ready to make this important decision.

Kindest,
Andrew

Customer:
After reading this site for a few weeks, it seems to me that you are the "medicine guru" around here.  I read all your posts with interest. It was a good intro.

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