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indinavir intensification

Jun 4, 2000

Hi, my partner is on crix/combivir, his first combination, and he has been undetectable (<50) for over 3 years now. However, he ignores the food restrictions and often takes his midday crix late. I've suggested that he try crix/ritonavir so he wouldn't have to worry about food restrictions or the midday dose. He thinks things are working the way he's doing it, so no need to change. Am I worried for nothing? Thanks.

Response from Dr. Stryker

Nope -- I think you are probably right on the money. Your partner is risking it all by taking Crix with food and/or skipping doses. Why go through the hassle of taking meds, and possible side effects, if you don't do everything possible to get the full benefit? Even though his numbers are good now, three year is a small time compared to the rest of his life. When someone is at risk of failure from "non-compliance", some kind of change is needed.

A couple of options. There is a lot of variability in individual patient Crix metabolism, so it could be that your guy is lucky and maintains very high levels despite his cavalier attitude. A trough drug level (in the AM before his first dose) could help figure this out. If he does this, it would be important to continue dosing as he has been doing, until after the test. If this verifies low or borderline levels, a change would be needed. Problem is , very few labs do this test -- and it isn't really standardized yet. I think he should just switch.

The Crix/Ritonavir plan would allow him a more convenient schedule, more effective blood levels of the drug, possibly lower risk of kidney stones, and possibly greater durability. Very few people have ritonavir side effects at this small dose -- I wouldn't worry about that. Good luck to both of you!


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