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When is 2 better than none
Jun 10, 2002

On June 5 you responded to similar question posted by someone else. I am now on my 4th combination of meds. Genotype tests and former (some very severe) drug reactions have led my MD to recommend current regime of Kaletra and Viread. She and I both recognize 3 drug combo would be best but she wants to go ahead and try this. She says some research and at least one other of her patients indicates this works well for some. Do you have any further information or comments?

Response from Dr. Young

Thanks for your question.

The response that I gave earlier was intended for the general patient situation. Yours ceratinly appears to be different-- these situations often require outside-of-the-box thinking (we've been doing this for years in HIV care). Both drugs (Kaletra and tenofovir) appear to be among the most potent in their respective classes. As such, it is not unreasonable to try the two as a two (really two and a half) drug regimen. To my knowledge, there are no studies of this combination that have been presented, though I am sure that there are a number of patients on this combo.

Based on a previous Abbott-sponsored study of ritonavir/saquiinavir (called Prometheus, presented in part by Cohen at the 9th Conference on Retroviruses); the premise that potent boosted (or dual) PI regimens have sufficient potency to suppress HIV seems reasonable. In this study, patients that did not achieve undetectable virus loads early had stavudine (d4T, Zerit) added to the regimen. Overall, about 2/3 of patients suppressed, comparable to other so-called standard of care regimens.

I'd certainly recommend close lab follow up of your viral load reductions; adherence as always (and maybe more for this regimen) will be critically important.

Good luck, stay in touch. BY



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