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Why so many pills?
Oct 7, 2003

Hi Docs, Right to the point: I was diagnosed July 03; August 03 CD4 was 84 and VL 553,000. I just started meds a couple days ago. I'm on a regimin that involves 13 pills a day (Combivir/Ritonavir/Invirase). I HATE PILLS. So much so that I seriously don't know which is worse, taking all the pills or not taking them and dying a slow painful death. Question to you: Is there a reason why my doc would put me on such a high pill count regimin, instead of one with much fewer pills per day? THANKS in advance.

Response from Dr. Young

Thanks for your question.

Firstly, anyone having difficulty with the side effects or hassle-factor of their drug regimen should discuss this with their doctor early in the game.

I'm not particularly good at reading the minds of other doctors (we are a tricky breed sometimes); my guess is that with your high initial viral load, that she/he wanted to use a dual- or boosted protease regimen because of the belief that such regimens may offer improved potency.

Ritonavir/Invirase if dosed at 400 mg each is a dual PI regimen (and should give you a pretty high pill burden). This is probably the best studied dual PI regimen (where both drugs contribute to antiviral effect), though there is little data that compares this to a strong boosted PI regimen like lopinavir/ritonavir (Kaltetra).

The later regimen (with Combivir, no less) is one of the top recommended regimens in this years updated treatment guidelines and would have a total of 4 pills twice a day. If pill aversion is really an issue, then newer PIs, like atazanavir or 908 (fos-amprenavir; not yet FDA approved) can offer even lower pill burdens (though somewhat less tested). Lastly, a non-nuke-based regimen can further reduce the pill burden, and has shown very good potency in persons with high viral loads.

Please discuss your feelings and potential options with your doctor. Good luck and let us know how things go. BY



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