Kaletra + Sustiva??
Nov 30, 2005
My doctor changed my regimen to sustiva and kaletra, because the nuke I was yaking were not giving complete suppression. What is your opinion of this two drug regimen?
Response from Dr. Young
Thank you for your post.
Here's from a 2005 Journal of AIDS publication:
Efficacy and tolerability of a nucleoside reverse transcriptase inhibitor-sparing combination of lopinavir/ritonavir and efavirenz in HIV-1-infected patients.
Allavena C, Ferre V, Brunet-Francois C, Delfraissy JF, Lafeuillade A, Valantin MA, Bentata M, Michelet C, Poizot-Martin I, Dailly E, Launay O, Raffi F; the Bitherapy Kaletra-Sustiva Study Group.
Service des Maladies Infectieuses et Tropicales/IFR26, Hotel-Dieu, Nantes, France.
BACKGROUND: Recommended antiretroviral regimens include a nucleoside reverse transcriptase inhibitor (NRTI) component. Class cross-resistance and mitochondrial toxicity are recognized as problems with this class of antiretrovirals. METHODS: In a pilot open-label study, 65 antiretroviral-naive and 21 experienced but nonnucleoside reverse transcriptase inhibitor-naive HIV-1-infected adults were given a combination of lopinavir/ritonavir (533.3/133.3 mg twice daily) and efavirenz (600 mg once daily) for 48 weeks. RESULTS: At baseline, the mean viral load was 4.84 log10 copies/mL and the mean CD4 count was 311 cells/mm. At week 24, the proportions of patients with a viral load <400 copies/mL were 78% and 93% using an intent-to-treat and on-treatment analysis, respectively. At week 48, proportions were 73% and 97%, respectively. Treatment discontinuation occurred in 21 patients during the 48-week period, with 33% of those attributable to drug-related adverse effects. A viral load >400 copies/mL at week 24 or 48 was associated with nonadherence in 3 patients and virologic failure in 1 patient. After an increase during the first 8 weeks, fasting lipid levels remained stable up to 48 weeks. CONCLUSION: The lopinavir/ritonavir-efavirenz combination is associated with a high rate of virologic response and should be compared with more classic NRTI-containing regimens in randomized and controlled clinical trials.
Understanding the basis of your lack of response of the nuke-based regimen is important- which nukes were used? Was there a problem with adherence to any part of the regimen (or dietary restrictions)? I think that the key issue relates to the pattern of drug resistance (if any) that you were experiencing prior to the treatment switch; any time that I switch a patient's regimen, I'll want to keep a very close eye on adherence, side effect issues and of course, viral load changes.
Good luck, I hope this helps. BY
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