Truvada/Reyataz/norvir vs. Truvda/Sustiva

[Erico]

Hi there,

I've got an appointment with my doc tomorrow (Thursday) and, well, it's time for me to start meds.
I've been poz since 2002, my CD4 are now about 300 despite a low viral load (average 3000-6000).

I have to say I did not expect this to come that fast, the percentage felt quickly from 25 to 16 withing one year. My doc really wants me to take the Truvada/Sustiva combo. I mean, he really insists on it.

 I personally decided to start with Truvada/Reyataz/Norvir combination due to what I heard about Sustiva and the fact that I have to work at night (I'm a freelancer). This combo was just "validated" last summer by the European Union as first treatment and seems to be a bit exotic here for first line therapy.

I read about Ann's Sustiva experience http://blogs.poz.com/ann/archives/2008/09/a_virgin_no_mor.html  (thanks Ann) and, well, I wished I had the opportunity to try this stuff before making a decision.

Anyway, I know this topic was discussed many time, but I just need your thoughts about this and kind of reinsurance that my choice is ok. I'll probably have to discuss about all this in detail with my doctor and explain my position, so any thought about  the pros and cons between Reyataz//Truvada/norvir and Truvada/Sustiva is welcome.

Keep well 

Eric

[Sydney]

Hi Eric,

I had the same combo (Truvada/Sustiva) strongly recommended to me by two different doctors.  For the same reasons as you have, I was very uncomfortable about the likely side-effects of the efavirenz in Sustiva (here called Stocrin).  So I did my research, opted for Viramune (nevirapine) instead of Sustiva, and stood my ground with the doctors.  (See my post about a month ago).  Peter Staley endorsed the reasonableness of my choice of Viramune over Sustiva (see his response in my post).  My doctors also endorsed that it was an acceptable alternative, given my relatively low viral load.

So in addition to the combo you're thinking of, you might also consider a Truvada/Viramune combo.  As I understand it, Sustiva is a very potent combination - warranted especially when there are high VLs (cca 100,000 or more).  But for lower viral loads, Viramune (combined with either Truvada or Epzicom) is effective and fairly benign in terms of side-effects.  You might find it helpful to do a search on Viramune - there's some very helpful information on the site.  For different experiences with the Truvada/Sustiva combination, read the posts on Atripla (which is the same combination in one daily pill).

I hope that helps.  And good luck.