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Re: PI monotherapy

Dec 17, 2007

I was intrigued by your reponse to the question about PI monotherapy. Based on what Ive read here and in other forums I expected a resounding NO to this idea, but your response was quite the opposite.

I have been infected since early 2005, not on meds. CD4 counts ranging from 350 520 at roughly 30%. VLs from 150 to the latest at 6,000. Low RC. Hoping to hold off meds as long as possible. As you can see, Im sort of on the cusp all I need is a downward trend or a change in the treatment guidelines and Ill find myself in the treat category.

My phenotype and genotype show no resistance to any PIs but resistance to all the NNRTI group. Mixed results in the NRTI group. Subsequently everyone agrees that when it comes time for meds a boosted PI regimen is the obvious choice. But then the opinions are varied about what NNRTI to use. Some say add AZT others Abacaviretc. A lot of medication, a lot of expense, a lot of confusion.

I would love to be able to go with boosted PI monotherapy, especially with Kaletra. Im an MD and trying to explain the jaundice I might get from Reyataz could present a problem.

Im hoping I can hold out as long as possible not needing meds, hopefully to a point when this kind of therapy will be more acceptable.

Any other thoughts on this?

Response from Dr. Pierone

Hello, and thanks for posting.

Kaletra monotherapy is an acceptable treatment option in my book. It works as well as many triple drug combinations which are included in the guidelines. It does not work every time, but when it does not lead to full viral suppression, the regimen can be intensified to achieve an undetectable viral load. Now that Isentress is on the market there is another option for intensification besides some of the older (and more toxic) nucleosides.

Please keep us informed about your progress and best of luck!

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