HIV newswires recently heralded a study showing that one type of regimen rocks, packing antiviral punch and few side effects: two or three nukes—AZT (Retrovir) + 3TC (Epivir), with or without Ziagen (abacavir)—plus non-nuke Sustiva (efavirenz). Cornell’s Roy Gulick, MD, and colleagues found that the nukes-plus-Sustiva combos worked better than the nuke trio AZT/3TC/Ziagen alone—the drugs in Trizivir—regardless of baseline viral load and CD4 count. A Harvard crew saw AZT/3TC/Sustiva trump a three-drug brew of ddI (Videx) + d4T (Zerit) + protease inhibitor (PI) Viracept (nelfinavir). The star even held its own against four-drug combos; it didn’t spike body and blood fats as much as the ddI/d4T/Viracept mix did—and by starting with Sustiva, you save PIs for later, when you may need them more. (Fed guidelines list AZT + 3TC + PI Kaletra as the other top choice.)

Too good to be true? Well, folks with anxiety or depression might not choose Sustiva, which can darken the blues and cause other mental side effects such as insomnia (see “The Great Depression,” POZ, February/March 2004). Sustiva can also cause birth defects, so look elsewhere if you’re pregnant or planning to be. Finally, it reaches higher blood levels—and causes more side effects—in African Americans.

Then there’s adherence: Harvard’s Martin Hirsch, MD, says those on AZT/3TC/Sustiva must take all their meds on time—relentlessly. Single mutations can make HIV resist 3TC and Sustiva, so Hirsch says, “If adherence is likely to be a problem, consider a more forgiving regimen”—one that won’t let HIV multiply after missed doses. But the real story here is old news: One size never fits all in HIV medicine, so work with your medical team to find a treatment starring you.