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Londonguy:
Hey guys, you seem like a nice group of people, hope you can give me some advice.

I'm 20, been diagnosed for a year and currently have a CD4 of 188 and a VL of 37,000.  I'll be starting treatment next Thursday and have been given a lot of stuff to read to help choose what I take.  I'm basically trying to choose between Sustiva and Truvada or Sustiva and Kivexa (I believe it's called Epzicom in the States).

This has presented me with quite a dilemma.  There seems to be a suspicion that Truvada may be problematic for the kidneys.  On the other hand Kivexa presents the possibility of a severe allergic reaction.  What a choice!

Since I'm living at home and haven't told my parents about my status (and have no plans to at the minute, it would be a nightmare), the thought of getting an allergic reaction is wholly unappealing because it would be extremely difficult to explain away.  This is causing me to lean towards Truvada, but the kidney worry is in the back of my head.  So if you could help I have a couple of questions

If the Truvada did present me with kidney problems, would stopping the treatment allow my kidneys to recover or would it be permanent?

In this event would I be able to switch to another option from the NRTIs?  I'm kinda scared of being ruled out of a whole class of drugs.

I know I'm probably worrying over nothing.  I know Truvada and Sustiva is highly recommended as a first line HIV treatment but the thought of permanently damaging my kidneys has me concerned.

Many thanks for any advice you could give.

Cliff:
Truvada will only be a concern with your kidneys, if you already have some sort of kidney impairment.  If you don't, then you shouldn't have any problems.  Truvada is a very popular drug and works well for most individuals.  Issues with kidneys are, thankfully, rare.

Don't read too much into the side effects and potential problems with the drugs.  Yes, they do exist but problem is all HIV meds have their share of problems, (they all can potentially impair an organ, whether its your liver or your kidney).  They all may cause an allergic reaction (of course, some more than others).  So if you're looking for that perfect combo that has not had any issues with liver, kidneys, potential allergic reactions, or any other harmful condition, I'm afraid that you will be searching, fruitlessly, for a very long time.

Good luck.

kcmetroman:
Hey London,

I think that the Truvada/Kidney issue is a bit overrated.  I have been talking to my ID doc about changing over from Combivir.  My concern with the Combivir was Lipo as well as possible anemia (along with the fact that AZT scares me).

Well, when I was diagnosed in the hospital last year, they found out that I was born with only one kidney.  My doc says no problem.

Blixer:
Both combos are very good I think.  I didn't have an allergic reaction to the Epzicom, but I did have a reaction and after 17 days had to stop it.  In retrospect, I wish i would have started with Sustiva and Truvada.  At any rate, as has been mentioned, don't read too much into the side effects.  I have had no ongoing side effects from the Sustiva.  I don't even get the vivid dreams.  I have had muscle pain from some others, but after about 3 weeks that seems to be starting to resolve.  They say the first week can be really rough for some and even up to a month.   But everyone says it does get better.  And I can now say that same thing.  Good luck!

newt:
Hey, hello London from sunny, sunny Brighton

Sustiva is a popular and effective first-line drug, but it can screw your head at the beginning: be prepared.

I, personally, would start with Truvada rather than Kivexa because both Sustiva and the abacavir in Kivexa can cause a rash, it can be hard to tell which is behind it. The comments from others on Truvada and kidneys is sound. Your clinic should so a urine dipstick test before you start (for creatine and glucose), just to check your kidneys are okay & then every time you go for a check-up. If you do start Kivexa, be aware of the signs of abacavir hypersensitivity reaction.

I am surprised no PI option.  Did your doc discuss the advantages/disadvantages of NRTI v PI combos, or just annouce it would be Sustiva? Reyataz, a once-a-day PI, is popular in London...... If Sustiva turns out to be no good, then I guess the docs may be reaching for this, or perhaps Kaletra, as an alternative.

Telling your family is a whole other issue - but, unless you are lucky, it is kinda hard to appear normal on Sustiva for the first 2-3 weeks.  And the same may be true of other combos, for different reasons, eg food restrictions. 

I was chatting with some friends about "non-disclosing" first-line combos, and we concluded Reyataz/Kivexa is the best current one cos the chance of side-effects at the beginning are least, n the packaging is small, no refridgeration is needed & you avoid the "non-food before bed" question that you get with Sustiva (eating food, esp, fatty stuff before taking it increases side effects).  But...but, but, starting combo has the potential, cos of side effects and, er, the drugs being discovered, has the potential to disclose yr status for you.  It may be an idea to think about how you are gonna handle this before you start off on your combo journey.

Good luck, let us know how you get on

- matt

PS: if you doc says something like it HAS to be Sustiva & you MUST tell your parents, this is wrong, kick him

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