Response from Dr. Sherer
Since Truvada is a once daily co-formulation of tenofovir and emtricitabine, your question is whether lopinavir (Kaletra) can be safely given once daily.
In my opinion, yes. The most recently conducted trials of once-daily lopinavir have been in combination with both Truvada and an different co-formulated once daily NRTI combination, Emtriva, which is abacavir plus lamivudine once daily.
Earlier studies of SIX lopinavir GEL-CAPS once daily showed excellent bioavailability of the drug, though the levels achieved were only about one half those achieved with the twice-daily dosing. The other difference was a higher rate of diarrhea, i.e. 11% compared to 6%. These differences were enough to lead me to only recommend the once-daily lopinavir in patients who were naive to all drugs, or at least naive to PI drugs, to ensure that there were no prior PI mutations, and that the modestly lower drug levels would be sufficient to control the virus.
The new TABLET formulation of lopinavir requires fewer pills, i.e. FOUR once daily or TWO twice daily, and is associated with fewer GI side effects, particularly less diarrhea. In a recent comparison of once- and twice-daily lopinavir in naive patients, once-daily lopinavir performed as well as twice-daily, including patients with low CD4 cells and high baseline viral loads.
In sum, the combination of once-daily truvada and lopinavir is a reasonable alternative for a boosted PI-based once-daily regimen in a drug-naive patient.
In your situation, the answer would depend on the results of all of your resistance tests. If, as you suggest, you have had no evidence of previous PI resistance, I would have no problem with the use of this regimen.
I suggest that you talk to your doctor about your concerns, and take this web exchange with you.
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