Newly Diagnosed and Once Daily Options?

[kr3900b]

Hi everyone,
So I was diagnosed three weeks ago today.  It's been a very remarkable three weeks I must say.  I've received great support from a close friend, my most recent ex, and a community support seminar here in San Francisco.  I'm currently awaiting my resistance testing results, which should be back in another 1.5 weeks.  Pending that, I'm trying to come to an educated recommendation on what meds to go on.

My baseline CD4 count was 249, VL 50,000.  I have requested one additional blood test for my next visit when I review the resistance results so we have some sort of trend albeit just two data points.  Obviously I want to go on meds ASAP with CD4 count that low although I have been pretty asymptomatic up to now.

My doc, who is actually a NP and poz himself, recommends Viramune + epzicom and suggests staying away from Atripla due to the Sustiva side effects.  I'm totally on board with staying away from Sustiva... But I've found that choosing your regimen is like buying a new house - you are never going to find the perfect house and it is really much an individualized decision.

Having said that, what recommendations do you have on once daily regimens?  I was seriously contemplating Complera, despite its new entry into the market, but what worries me most is the 400+ calorie requirement for food.  I'm on a diet and will continue for some time that has me eating small meals throughout the day of around 300 calories each.  So rather than interrupt my needed weight loss routine, I'm thinking Complera might not be an option.

It seems like Truvada is more popular that Epzicom?  Any particular reason?

If taking Truvada/Epzicom + the new Viramune XR dose, then effectively it is two pills once a day regardless of food intake? 

And it looks like the health guidelines downgraded the Epzicom/Viramune mix recently in favor of Complera?  Any body have more details on why?

Are there any other recommended once daily options I'm not seeing?  Of course the upcoming quad pill seems like a great alternative.

Really appreciate any thoughts you have on my tons of questions!!!

[newt]

Hello

Truvada is more popular than Epzicom for first time treatment because it carries no serious risk of allergic reaction. Although there is a test for this, it's not 100% certain. This said is is very unusual for people to get an allergic reaction if they pass the test.

Truvada and Epzicom are probably equal really. Some minor considerations for personalisation eg kidney function vs cardiovascular health. But pretty much moot.

Viramune XR vs Sustiva. Well, yes, tis well known, the trippy/sleepy effects of Sustiva, but the do usually pass and some people can take this drug like M&Ms. On the other hand, yes, it does do some people's heads in good and proper. There is only one way to find out (ie take the drug). Viramune is just as (and perhaps long term a bit more) effective. There is 3 times the risk of a serious liver/rash reaction on Viramune vs Sustiva, but it's low in both cases, like 0.3% vs 0.1%.

Alternative 1 x day options are two protease inhibitors. Reyataz (can be done unboosted or boosted with Norvir if you use Epzicom) and Prezista. Prezista has less side effects in my experience.

I agree about the food/Complera point. It does need a shed load of calories to work properly.

If your doc do or don't like a particular drug because of side effects, make sure it ain't fashion. There is data on side effects from scientific studies. Either Truvada of Epzicom plus either Sustiva or Viramune or Reyataz or Prezista will be equally effective and can basically be side effect free. Or not side effect free. Depends really on how you take to the drugs The choice, resistance test aside, should really reflect what risks (ie side effects) you prefer to accept.

There will be more once a day options in the near future, so consider whatever you take now a starting point.

- matt.

[kr3900b]

Thanks Matt for the great advice. What throws me off a bit is when the doctors don't recommend epzicom/Truvada as first line for treatment naive patients. Part of me wants to try atripla but those side effects seem so crazy. I need full control of my mind at work... I might have to suck it up and eat more and go with complera for the time being...