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Cocktail for drug resistant virus
Dec 28, 2004

I had a break of 16 months from anti-retroval treatment since I couldn't handle the Crixivan. During the break I had a tonsillectomy.My counts worsened to a CD4 of 250 (from 580) and viral load of 115 000 (from 20 000). My new HIV specialist recommended a cocktail that include Kaletra, Invi-rase, Viread and Ziagen. I did only a bit of reading on these drugs and have the following questions: (a) Do any of these drugs pass the into the brain area and if not, is it criticial to add/replace for a drug that is effective - unfortunately drug resistance tests showed resistence to many drugs in the non-protease-inhibitor classes (excl fusion inhibitor) although I was not taking all of these drugs when the test was conducted (b) I read that there is an improved drug in place of the Invirase would it be better to replace Invirase with this drug although I understand that Invirase in combination with one of the Kaletra composites (c) Any general comment on the recommended combination. Would really appreciate response. Thanx (Have been HIV+ for 6 years)

Response from Dr. Pierone

These antiviral medications do cross into the brain in more than sufficient amounts to prevent viral replication in the central nervous system. I am not sure what medication you read about in place of Invirase, but the most sensible regimen really depends on the results of previous resistance tests. I can say that Invirase is often used in combination with Kaletra in situations where there is multi-drug resistant virus. This regimen is very potent, but not that well tolerated due to gastrointestinal side effects. There are some experimental protease inhibitors that also work for multi-drug resistant virus Tipranavir and TMC-114. Tipranvir is nearing approval within the next 6 months. Hope this helps, good luck to you.



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