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what's best for me?
Apr 8, 2001

Dear Doc,

Currently on Crixivan (800 mg, 3X daily) Combivir 2X daily), its the only thing I have ever taken, for more 4 years now (Combivir replaced AZT/3TC seperately about 2 yrs ago). My VL was low but would bounce around a bit, heading up in general --- 50 to 160 to 380 --- in my last three tests; CD4 is good, between 500-600 going up.

As a result of VL (a P-type reistance test was done that showed a very LOW level resistance to the Crix), my MD decided to add Norvir to boost the Crixivan, good cause I do the whole thing 2X daily w/o the food restrictions (hooray), but bad because of side effects (nausea, diarrhea, and after only 3 months increased cholesterol and triglycerides --- is this really possible by just adding 400 mg of the Norvir to the Crixivan?!?!) Also, to date at 34 I am healthy, but have insulin-dependent diabetics in my family, older on-set in paternal grandmother (she had her legs amputated, the whole thing...), and 2 of 4 uncles on that side...

My question is this... I am a candidate to switch to a more "current" 21st century combination? If so, knowing what you do (very low resistance that I know of --- I am very compulsive about taking my pills), what would you recommend to keep numbers good, keep side effects low, and keep # of pills to a minimum.

OR are you, like me, of the mindset that if it ain't totally broken (I have gone more than four years, longer than anyone I personally know), don't mess with it... saving those other, perhaps friendly options, for later?

If I was your patient, how would you advise me?

Thank you,

Marc G.

Response from Dr. Boyle

I am surprised by the phenotype results, first because you generally cannot get a phenotype at such a low viral load and second because in most Epivir containing HAART regimens that is the first drug to fail. Regardless, at this point, given your problems with tolerating Crixivan/Norvir (which about 1/3 of patients have), your elevated triglycerides with that regimen, and your family history, I would consider changing you to another, simpler, equally potent regimen, such as Videx EC, Zerit and Sustiva.



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