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combining crixivan and norvir
Mar 14, 2000

In april 1999 you have answered the last question on combining norvir and crixivan. I would like to know if due to new results in research work have changed your opinion since.

I am taking AZT for 8 years now, 6 years ago I started combining it with 3TC (after a ddi failure) and in March 1996 I started Crixivan and went on using a triple of AZT, 3TC and Crixivan (on a 3 times per day dose of 800mg each).

Four years later I now have a viral load of <40 and my t/cells vary from 300 - 400.

I would like to change to taking Crixivan twice a day (what dose would it be?) combined with Norvir (100mg) but have some questions: WHAT must be eaten together with the drugs (fat or.....? if at all), is it necessary to take the drugs exactly every 12 HOURS, what is known about the effect of adding Norvir after such a long time of using the triple combination already and would you ADVISE me to do it at all? Any additional advice would be very helpful.

FYI I did not have any major infections yet, apart from micro- and cryptosporidium and campilobacter.

Response from Dr. Cohen

Happy to update.

The news continues to be reassuring - that for those on Crix every 8 hours - there are two major ways that things can be switched. One is the lower dose ritonavir with higher dose Crix - this usually is 200 mg riton with 800 mg Crix - both twice a day. There are NO food restrictions - you can eat fat, or snackwells no fat chocolate cremes, or just celery if you prefer... altho in general, these meds are better tolerated when there is some food around, but it would be up to you. This approach has less ritonavir - and is thought to be a bit more likely to be tolerated that higher doses of ritonavir on average. But one concern is that you should keep up the water intake since there is still the chance of a Crix kidney stone...

The alternative is 400 mg of BOTH riton and Crix twice a day. More ritonavir allows less Crix - again with or without food. And maybe less need for the water issue since the Crix dose is lower overall... although to be fair we don't really know for sure if there is a difference in the water intake of these two approaches.

The intellectual battle between these two approaches continues - without resolution. There are reasons to go in either direction - altho based on what you are saying, either would be successful in keeping your HIV under control. The question is in part how you feel on ritonavir - if you do Ok with it, you can discuss the two different approaches with your provider. But if you don't tolerate it too well - then you can just go with the lower dose - which many can tolerate. There is even some work going on with just 100 mg (one capsule) riton with 800 Crix twice a day as a backup in case you need it - the study of that approach in now going on...

Either way - the 12 hour is not strict - one of the benefits of this is the levels of the Crix are higher buying you more flexibility. Though don't miss it - it is still twice a day...

Hope that clarifies.



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