Nov 7, 2005
Hello-- I have a question about drug combinations--Currently I am on Kaletra, Sustivia and Combivir--have been on this for several years--First combo was Viracept, Epivir and Zerit--Doctor switched me current regimen due to the fact that I could not go undectable and had lactidacidosis readings(which could have been false)--also all genotypes have reported I can take anything (If I remember correctly)--well to my current dilemna my insurance company is now going to a percentage copay and a max on dollars used for drugs per year and I can not afford my current regimen---I have been to my caseworker and due to me having insurance and limited funding available I am only eligible a very small amount of help---I have done a lot of research in the last few days and have come up with 5 drug combos which I can somewhat afford and will not put me over my yearly allowance and they are as follows 1.Epivir/Sustiva/Videx 2. Sustiva/Truvada 3. Viramune/Truvada 4. Sustiva/Viread/Epivir and 5. Epzicom/Sustiva with plan 1 being the most affordable to me---What is your opinion on these five options and is there anything else I can recommend to my doctor---It is either this or run out of drugs at weeks at a time until I can afford the copays--THANKS FOR THE HELP
Response from Dr. Wohl
I take it that since you have been on your regimen your viral load is persistently undetectable. If so, you have several options. The bulk of the expense for you is the use of Kaletra and Sustiva together, especially since the Kaletra is likely dosed at 4 pills twice a day.
You could switch your regimen completely as you suggest. If you are doing well and have never had evidence of drug resistance a few simplier options may also exist. Dropping the Sustiva and remaining on Combivir and Kaletra (now down to 3 pills twice a day) should help. AZT is now generic and 3TC is cheaper than Combivir. A rub is that Kaletra will come out in a new formulation and thsi will be slightly more expensive than old Kaletra.
Similarly, you could try to drop the Kaletra. I am a little less keen on this given your persistent detectable virus on your old regimen. Resistance could have accumulated to d4T and 3TC and by extension to your AZT and 3TC. That would leave Sustiva doing the heavy lifting mostly by itself and that it can not do. For similar reasons, your listed choices would be somewhat less appealling than something that keeps Kaletra in the mix.
A more radical approach is to stay only on Kaletra. This has been studied in small numbers of patients on early therapy and had performed very well. This would take some guts especially given you have been on treatment before with a protease inhibitor.
I hope this helps.
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