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Going off abacavir

Mar 4, 2007

Dear Dr. Pierone:

Thanks so much for your past contributions. This website is an extraordinary help for those of us who seem to have new questions almost daily. Here's my question: My partner was diagnosed with AIDS in 4/06. We have figured out that he's been positive for about twenty three years. Back in April his viral load was over 100,000 and his cd4 count was 76. He's been on two different regimens. His most recent combination is Norvir 200mg, Invirase 2000mg, Emtriva 200mg, Ziagen 600mg and Mepron. His viral load is undetectable at present and his cd4 count is 140. Some doctors have raised their eyebrows at this combo but my partner has only one kidney and has elevated liver enzymes (about three times higher than they should be). We're very concerned now because our doctor has taken him off the Ziagen due to what appears to be neuropathy (severe pain in his arms and feet and numbness in his hands)and heavy nausea. We are scheduled to see a neurologist this week and our doctor wants to wait to see those results before he replaces this part of the combo. Isn't this dangerous? We're worried about him being without the RTIs in his combo with his t-cell count so low. Despite the neuopathy he's in pretty good shape right now, just a little thrush at the moment. How long can he be without something like abacavir before we're in serious trouble? Thanks in advance for all your help!!

Sincerely, GD

Response from Dr. Pierone

Hello, and thanks for posting.

There are emerging data on the use of protease inhibitor "mono"therapy in HIV infection. The studies thus far have shown that a Norvir-boosted PI alone is almost as effective as a boosted PI and 2 nucleosides. The studies have been done with Kaletra, Reyataz, and Crixivan, but not Invirase. Since Invirase is similar in potency to these other agents it would probably work as well.

So what does this have to do with your partner? For the time being, your partner is on dual therapy, and although we have no data on dual therapy with a boosted PI and one nuke, it will probably maintain an undetectable viral load based on the research experience with monotherapy. Although we try not to practice medicine based on anecdotal cases, for what it is worth I have had patients on Novir/Invirase only who have maintained long-term viral suppression. They ended up on this atypical regimen because of intolerance or resistance to the nukes and NNRTIs, but still did very well.

By now his regimen has likely been adjusted and hopefully his medication-related side effects brought under control. Let us know how things are going and the outcome of these changes.

I have to choose a drug for first regimen
Best first-line regimen with fewest side effects

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