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Your advice again
Oct 24, 2004

Hi doctor Young! It is me Dav again.Thank for your immidate respod on my question on trizivir and norvir on october,16,2004.I live in Africa and the problem is limitation of drugs and their costs.The other alternative which I have is to start with Reyataz,Norvir,Epivir and Retrovir.What is your advice and their daily dose? Thank,Dav.

Response from Dr. Young

Thanks Dav for your follow up and clarification.

I can now understand your initial question with greater clarity-- as such the issue with ritonavir is that it should be dosed (as a single PI) at 600 mg twice daily. This can be problematic, largely because of the frequent gastrointestinal side effects.

A entirely once-daily combination of atazanavir (300 mg, Reyataz) with ritonavir (100 mg, Norvir) with 3TC (300 mg, Epivir) and AZT (Retrovir) should be very effective and much better tolerated that the Norvir-alone PI regimen that you've mentioned before. Moreover, while the ritonavir-boosted atazanavir regimen has yet to be fully studied in treatment naive persons, boosted PIs are clearly gaining popularity here in the US. The once-daily option is also clearly an advantage.

The key to any atazanavir regimen is knowing that the medications (while once-daily) must be taken with meals and antacids should be taken only with your doctor's supervision, since both have the potential to dramatically lower your atazanavir drug levels (and hence the drug's potentcy).

I hope this helps, let us know what you and your doctor decide and how things go. I'm sure that this information will be very important to many of our readers. BY



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