What medication start treatment with?

[Morethan]

I found out about my poz status in March CD4 760, VL 1200, 37%

My last visit in Aug I was down to 630, VL 6,530,28%

My doctor was to meet in Oct and discuss starting treatment.  Obviously I want to get the meds that are more effective but Im terrified about lypoathropy since it would give it away with my family about my status.  Any recommendations overall and what you guys know about if any meds besides not using Zerit you recommend to minimize lipo effects?

[newt]

Hello, welcome

First, let's discuss the starting treatment now thing. It seems dead popular in, eg the USA, and while some science supports a short course of treatment for new (rather than newly diagnosed) infections, on the basis it helps the immune system adapt to controlling the infection, the long term benefits are unproven. Treatment during early is the subject of a big international trial at present.

The disadvantage of early treatment is side effects, and you are right these might disclose your status to eg family.

Current US guidelines recommend treatment at a CD4 count of around 350. However, when you start treatment is a personal decision and some people start with higher/lower CD4 counts.

Your CD4 count is normal (500+).  CD4 tests vary, so one or two sets of labs don't say much. You need to look at the trend. Same is true for viral load.

On lipoatrophy, the d drugs (d4T and ddI) and AZT, if you avoid these the risk is practically eliminated.

Alll drugs have side effects, and some are more obvious than others. Not everyone gets side effects, indeed they are mostly mild, but some have the potential get people asking if everything is alright, and it can be difficult to find a plausible reason. Eg if one of the drugs is making your head trippy what do you say? or giving you the frequent squits what do you say? Some drugs need refrigeration, taking with food, so practical considerations about storage, meal times etc can also trip you up.

First-time treatment is usually 3 drugs from 2 different drug classes. This means 2 nukes + either a non-nuke or boosted protease inhibitor (PI). 

For non-nukes the choice is limited to Sustiva or Viramune, for the PIs there's more meds to select from.  The most popular nukes these days are Truvada (tenofovir + FTC in one tablet) or Epzicom (abacavir + 3TC in one tab).  Combinations made up from these are all effective and durable.  There is no best combo, getting one that works for you and fits with your life is what's important.

You are new to this game, and have plenty of time to investigate, discuss, come to terms etc.  Treatment now is an option but not critical to your life and health.  I would, personally,  take as much time as needed before making any decisions on treatment, disclosure etc etc etc.

- matt

[woodshere]

There is no best combo, getting one that works for you and fits with your life is what's important.

Very important!!!

I had to start treatment immediately after diagnosis.  My doctor recommended several options.  We discussed the pros and cons of each option regarding possible side effects and being adherent.  I chose the one that I felt fit into my lifestyle the best.

Good luck,
Woods

[blondbeauty]

There are a few once a day treatments. You can find them in this website "lessons" section. All of them are effective provided your virus is not resistant to any of them. Regimes containing AZT and D4t are not once a day treatments.

[Tim Horn]

Morethan:

On top of the comments you've received here, check out our "When Should I Start Treatment, and What Should I Take First?" lesson.

Tim Horn

[kellyspoppi]

morethan,

this advise is coming from a long term survivor who didn't begin meds for the first 10 years, and during that period, we only had CD4 counts to go by. over that same period my cd 4 ct went up and down considerably more than i expected, but always between 450 and 850. stress and illness's like colds and flu can do that to you easily. if i went to someplace that really relaxed me (ie. the ocean), they could jump up 200 points between every 3 month check up.

what is important to me to know is although you say you were diagnosed in august, had you just had a risky experience and decided to get tested, or do you think you were infected quite some time ago and were begining to get sick alot and thats why you got tested?

soon after the infection, it will take our immune system a while to recognize what we are infected with before it knows how to respond, so you may be seeing the decrease in cd 4 and increase in VL while the body is responding to the hiv. if that is the case, continue to keep getting yourself monitored and use the cdc guidelines as your guide (350 cd 4 ct and 100,000 VL).

before you start any regimen of drugs be sure to have your dr order a geno type and pheno type screening to see what drugs you might be resistent to already, because you may have been infected by someone who was already on meds at the time. any the drugs they were resistent to, you will be as well.

keep the faith and don't panic.

kellyspoppi
  

[Morethan]

This is all great info.  I have my next appt in early OCt and will it with my doctor.

Thanks