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Correct Rx?
Sep 24, 2006

I was diagnosed in mid 2002 and started my first cocktail in mid 2004, when my CD4 fell below 300 for the first time, with VL hovering around the 20,000-40,000 mark. I remain on my first once daily cocktail of 1400mg/Lexiva + 100mg/Norvir + Truvada. After 2 years, my CD4 seems to have stuck at around 375-400, with TCells hovering between undetectable and 100 or 200 and CD% about 22-24%. My doctor says this is fine and I shouldn't get hung up on staying undetectable because my detectable scores are so low, and % is staying strong. I keep wondering, though, if the norvir at 100mg is the problem here as I can never find this as a recommended RX - it's always 200mg per day on a once daily regimen. Is my 100mg Norvir "approved" and would an additional boost from it possibly take me into the truly "undetectable" zone?

Thank you so much for your help with my nagging problem!

Response from Dr. Wohl

You raise important questions. You have had a nice drop in your viral load but not to undetectable (i.e. less than 50). Your CD4 cell rise has been decent but somewhat underwhelming.

There are some data looking at using 100 mg of Norvir with Lexiva rather than the typical 200 mg that suggest this lower dose may be effective. A comaprative study is being conducted currently in the US (I am a study investigator) and more info will be presented on this trial later this year and early next year.

I do not see much harm in trying to increase the Norvir to 200 mg. I would also see if a genotype resistance test can be performed on your low level virus before the increase is made. Any major resistance mutations would be a cause for concern and may prompt a regimen switch. Lastly, more Norvir may mean more side effects. Lipid should be monitored as is typical following any regimen change.

Let us know if it works.

DW



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