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Why switch my protease inhibitor when it's working?

Mar 25, 2012

Dear Doc,

My HIV specialist has suggested I consider changing the protease inhibitor in my regimen. I have been taking Kaletra (with Epzicom) since my diagnosis in late 2005. Most recent blood work shows undetectable virus and 802 T-cells. I take Tricor to balance the triglycerides and cholesterol which shot up when I first took the meds, but which have been normal for six years. Other than uric acid that the rheumatologist concluded had caused "disseminated gout" (I had it in my hands--VERY painful!!), I have no real side-effects of my meds. I did when I first started them (diarrhea, insomnia, etc.), but really nothing to complain of. I have been 100% adherent to treatment.

Here's my question, then: My doc suggests I switch out the Kaletra for Reyataz or Prezista. Reading about their potential side effects, and also the fact that you have to take an additional "booster" drug--and knowing how awful it was adjusting to the regimen I've been on all this time--I am really not keen to switch when it seems the Kaletra/Epzicom/Tricor combination is working fine.

Can you offer a second opinion?

Many thanks

Response from Dr. Holodniy

The only reason to switch, particularly to reyataz, would be a more favorable lipid profile. In other words, reyataz doesn't raise lipids as much as kaletra so you might not have to take the tricor. Other than that, I see know reason to change based on the history and response you have outlined.

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