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Your opinion please

Mar 27, 2002

I tested positive in 1991, started therapy in 1992 and am now resistant to virtually all the NRTIs and NNRTIs. Prior to now, I have not been on any PIs. My most recent tests were VL 23,900 and CD4 285. Prior to that time, my VL has fluctuated between 500 and 7,200 during the three year period I was on my previous regimen (Videx, Sustiva, and Ziagen). (Ive never really been undetectable.) As a result of my most recent test, my doctor switched me to Viracept, 8 tablets once daily, Norvir, 2 tablets once daily, Viread, 1 tablet once daily, and Epivir, 2 tablets once daily.

I have two questions: Does this combination of drugs sound like a reasonable regimen? Is once daily dosing appropriate for these medications?

Thank you for your help. With fewer options available for me at this point, I dont feel that I can afford any more mistakes.

Response from Dr. Boyle

There is no valid evidence to support the dosing of Viracept in this fashion and due to the difficult pharmacokinetic issues involved, I would not do it. If you want to be on a once-daily PI, Agenerase (amprenavir)/Norvir (ritonavir) has been FDA approved for once-daily therapy (at 1200mg/200mg), and there are data to support Crixivan (indinavir)/Norvir, Fortovase or Invirase (Saquinavir)/Norvir and Kaletra once daily. Also, given the high-level resistance you report to the nucleosides and non-nucleosides, I would consider a regimen that includes a true double PI (e.g., Fortovase/Ritonavir at 400/400 twice daily or Fortovase/Kaletra at 1000mg/3capsules twice daily).

new therapy
Alcohol and meds

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