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how about Maintanence therapy with Kaletra alone?
Aug 3, 2006

i been positive for 11 years, i was diagnosed during the hit hard hit early era therefore i was prescribed meds, later i was encoraged by my doctor to stop them since i relly did not need them, my tcells had never been under 500 and my viral load was undetectable,i been off theraphy for 7 years and my tcells are still obove 500 but my viral load ranges from 20000 to 50000, i like to get your opinion regarding the use of kaletra (alone) as part of a maintance regimen.

Response from Dr. Pierone

The first question is whether you need to be on therapy at all with a CD4 count above 500. The guidelines would suggest that you hold off on therapy. There is a nascent movement back towards hit early, hit hard, but we simply don't have the data to support this strategy. For fair balance, we also don't have good data that shows starting therapy when the CD4 count drops below 350 cells followed by continuous, lifelong HAART is the best approach.

When it comes down to choice of antiretroviral therapy it should be clearly stated that this is a moving target. As new agents and combinations of medications become available, standards of care evolve in order to accommodate these advances. There are limited data on Kaletra monotherapy which show that it is generally effective in suppressing HIV replication. Further, that if virologic failure does occur, resistance does not develop quickly, allowing for intensification to traditional HAART. We performed a small pilot study in which we switched subjects from triple NNRTI-based therapy to Kaletra monotherapy for one year. At the end of the year we asked patients which regimen they preferred and half decided to go back to triple NNRTI-based meds and the rest chose to stay on Kaletra monotherapy.

Suffice it to say that there are now many different effective choices available for treatment of HIV infection. Although none are devoid of side effects, the newer regimens do represent incremental advances in therapy.



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