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Naive choice - Prezista (Norvir boosted) + Isentress / CNS penetration
Jan 1, 2010

Dr. Bob,

I am presently 45, CD4 400, 60,000 viral load, planning to begin treatment shortly.

I am facing the decision concerning the medications with which I should begin treatment and after some research, I believe that Prezista (Norvir boosted) + Isentress could be a good choice.

My concern is about CNS penetration. Over the last year I have experienced increased forgetfulness and a somewhat worrisome loss of concentration. I have read that Isentress has low CNS penetration and have found very little information the Prezista + Norvir combo (concerning penetration.)

I would appreciate your comments about this regimen choice and about its CNS penetration.

Dès Montréal, je vous souhaite une très bonne année 2010 en vous remerciant encore une fois pour votre générosité et pour votre appui.

Robin

Response from Dr. Frascino

Salut Mec,

J'écrirai en anglais parce que je crois que cette information est assez importante et si j'écrivais dans la langue d'Asterix et Tintin, j'aurais peur qu'il y ait beaucoup de lecteurs qui ne comprennent pas!

Cognitive dysfunction is a significant and increasing problem for HIVers, particularly in older folks. Control of HIV replication in the brain (central nervous system, CNS) is extremely important. The CNS penetration of Norvir-boosted Prezista has been studied, and drug levels sufficient to control HIV replication in the CNS have been demonstrated in most of the study participants.

I'm curious as to why you are leaning toward Prezista plus Isentress rather than Atripla, Prezista plus Truvada, or Isentress plus Truvada for your first regimen. These are the current recommended regimens for naive patients.

Bonne annee 2010! Bisettes et Crepes Suzette!

Dr. Bob


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