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uses of kaletra?

Sep 24, 2006

i live in a fair sized city in canada about 2 hours west of toronto, toronto just hosted the aids conference and is a fast becoming(if not already) a global city. i have heard (second hand) that the specialist there are shying away from the use of kaltra. i am currently taking kaletra tenofovir, and abacavir, i am undeteectable and cd4s are in the 800-900 range and i sit at approx. 27%. i am not copmplaing about my treatment but i am curios as to how doctors relly decide what drugs will work best for you it seems lately that there is no guidline for prescribing. i have heard that katletra has some nasty side effects. should i be worried in the long term?

Response from Dr. Wohl

I was at the conference and liked Toronto, especially the Little India section where I had an amazing curry.

As far as Kaletra goes, this is a very useful and potent HIV medication. It has been studied now for several years and seems to be relatively well tolerated by most. Kaletra is listed in the US guidelines, along with efavirenz (Sustiva), as a preferred main component of initial HIV therapy. It is the only protease inhibitor that contains ritonavir- meaning less mediction bottles and co-pays. It has clearly done right by you.

In Toronto, we heard about several studies of Kaletra. In one, Kaletra and Lexiva/ritonavir were found to be indentical in their abilty to lower viral load and raise CD4 cell counts in people starting HIV drugs. The side effect profile of each med was also remarkably similar and mainly involved diarrhea in 1 out of 10 people and increases in cholesterol and triglycerides.

Kaletra has been considered to be more likely to lead to lipid increases; however, this study showed there to be no difference compared to Lexiva/ritonavir. Whether it is much different than other protease inhibitors, such as Reyataz/ritonavir, and if so, by what degree, remains to be seen.

Another study compared Kaletra and efavirenz and found that as an initial therapy, efavirenz led to a greater proportion having a viral load <50 at 96 weeks. The CD4 cell count change was greater among those on Kaletra and drug resistance was less likely to be seen in patients who failed Kaletra compared to those failing efavirenz - making this somewhat of a draw.

So, there are always new data to incorporate into our thinking and guidelines have a hard time keeping current, but I think the current guidelines we have remain valid. Doctors use these guidelines and then consider what would be best for the patient considering lifestyle, medical factors (viral load, CD4 cell count, drug resistance), drug interactions, financial considerations, side effect potenial etc. You are on a powerful combination. We all share concerns about the effects of HIV drugs after 10, 20 or more years. There is nothing to make me concerned about Kaletra above any other drug and its long history of use is reassuring.


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