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Boosting with Norvir
Jan 15, 2008

I have recently been prescribed an anti HIV regimen to replace the AZT-based regimen that had been taking without problem for many years as I was recently diagnosed with HCV and I want to start Pegintron-Copegus ASAP. The new regimen includes Truvada QD, Telzir (Lexiva)1400 mg QD and Norvir 100 mg QD. My understanding is that Telzir is being prescribed rather than Reyataz as the latter can prolong the PR interval and I have a Hx of stroke. Is it necessary to boost Telzir with Norvir, or could I avoid Norvir initially and take Telzir BID? (i.e. does Viread in Truvada interfere with Telzir as it does with Reyataz?)As I am PI naive, I believe the option of starting Telzir without Norvir is acceptable - is this also true in HCV coinfected patients? Why is Norvir being prescribed at 100 mg QD rather than 200 mg QD? As I have not yet had a liver biopsy or even an HCV viral load assessment and the genotype of my HCV is 1a, are these changes to antiretroviral therapy recommmended up front or should I wait to see what the specialist says regarding initiation of anti HCV therapy? My concern is that if I do not respond to anti HCV treatment, I may not be able to go back to the non-PI based HIV regimen (i.e. Trizivir)

Thanks very much for the feedback.

Response from Dr. McGovern

I suspect your provider wanted to take you off Trizivir due to the fact that AZT is part of Trizivir. AZT and Ribavirin, which is one of the drugs in the HCV treatment regimen, can cause significant anemia so many doctors (including myself) prefer to avoid that potential side effect.

As for the dosing of Norvir and Lexiva - you should ask your physician regarding this question simply because your history will be very important here. If you are protease-inhibitor experienced, we would usually prescribe 700 mg twice daily of Lexiva with 100 mg twice daily of Norvir with your Truvada. However, perhaps there may be other considerations. I would ask your physician specifically about the dosing. I do think these medications are good overall choices in terms of tolerability by the liver.

As for your HCV therapy: the most important thing I can stress to you is to take your medications with excellent adherence. It will be important to know your genotype and baseline viral load and then to have this monitored to see if the medications are working. I tend to get a viral load at 4 and 12 weeks of treatment. Be certain to review the side effects of the medications carefully with your provider.

Finally, my best wishes for a succesful outcome of your treatment.



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