Changing meds and probable pregnancy
May 31, 2013
Hello. We are a discordant couple from Argentina and we have a wonderful 5yo negative son. Since we moved to another city, my wife has now 2 different HIV physicians, one on the previous city and another one in the new city. Since we were planning to have another child she went through many tests in order to have some certainties that everything would be as good as we can do. Hopefully, she would be pregnant by now... :-D She is now taking Ritonavir 100mg + Saquinavir 1g + Lamivudin + Zidovudin twice a day. The last week, we were informed that Roche has stopped producing Saquinavir, and the option available (from Richmond Lab) causes her to have much rush. Because of that, we are facing now an imminent change in the medication schemata and the problem is that the two physicians don't agree in the treatment that she should follow. One one hand, the former physian advises her to move to Fosamprenavir + Ritonavir and she argues that this is good in order to have a clue in case this treatment would not perform well. On the other hand, the local physician would prefer to prescribe her Atazanavir + Lamivudina + Zidovudina + Ritonavir and she argues that the treatment suggested by the other phisician is old, as well as the current one. Now the focus is that we are in between two different oppinions and not enough time to decide due to the possible pregnancy. Would you please advise us between these two treatments and even suggest a treatment that may be available in Argentina? Thanks in advance for your advise.
Response from Dr. Young
Hello and thanks for posting from Argentina!
Assuming that your wife has not previously experienced treatment failure or drug resistance, then switching from the protease saquinavir to other protease inhibitors, like fosamprenavir or atazanavir can be done without much concern for effectiveness.
The different PIs differ in their characteristics- both fosamprenavir and atazanavir can be taken once-daily. Fosamprenavir can be taken without regard to food or antacids, while atazanavir should be taken with food (and avoidance of antacids). The later is arguably slightly more effective and better tolerated and has safety data around pregnancy.
What's probably most important is to find the regimen that she has access to, fits her daily activities and lifestyle- and, in the case of pregnancy, to find the medication that most effectively suppresses her virus.
I hope that's helpful and wish you well, BY
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