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Add Crixivan to Viracept, AZT, TC3 current treatment?
May 11, 2001

My current treatment is Viracept, Epivir, Retrovir. Test results: June 2000 low of 6 CD4 count, viral load 99000, first started treatment in June 2000. Test results since treatment: viral load undectable, slowly rising CD4 count to 86 currently. My Dr wants to add Crixivan to my current treatment continuing all current meds. What do you think about this plan? I am concerned about additional side effects, burning one of my future treatment option bridges, if its not broke, don't fix it... Thank You.

Response from Dr. Young

Thanks for your question.

From what you describe, it would seem that you are doing very well on your current regimen of nelfinavir/ZDV/3TC. Based on this, it isn't clear to me why you would need to make any changes, unless side effects of the medications or adherence were at issue.

There are some who have advocated using a more intense (potent) regimen to insure long-term durability of treatment. Strategies to acheive this might include the addition of a third nucleoside (like abacavir, or in combination using Trizivir); or the addition of agents to boost the drug levels of protease inhibitors, such as the use of ritonavir in combination with indinavir, saquinavir, lopinavir or amprenavir. Unfortunately, there is little gain by the addition of ritonavir to nelfinavir; hence, this protease inhibitor is largely used as a single, stand-alone agent.

There is little data about the dual use of nelfinavir and indinavir; hence it might be difficult to predict the exact pharmacokinetic interactions between the drugs and any possible side effects. Personally, I wouldn't go down this pathway.

Best advice is to continue to ask questions of your doctor as to the rationale behind any treatment changes. Stay informed.

Good luck,BY

Catch 22
Protease only combo?

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