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Patient's med?????????????
Oct 12, 2004

I'm a health care professionnal and came upon a patient with a regimen I have a hard time making sense of and couldn't reach his HIV/AIDS MD. On admission the patient was on these(and were actually just refilled not long ago at his pharmacy): Combivir 1 tab BID, Lexiva 700mg BID, Kaletra 4 tabs BID, Norvir 100mg BID, Efavirenz 600mg HS, Leucovorin 50mg po qd and mepron 750mg BID Would there be ever a rationnal for this combination? I don't have the resistance profile but this therapy must be burdensome. And what about the leucovorin (no bactrim,pyrimethamine etc)? I would really appreciate any comment or rationnal on this issue Thank you Stephan

Response from Dr. Sherer

For patients who have failed multiple ART regimens, HIV physicians will seek to use any drugs that have any indication of residual activity to try to help the patient. Often such a regimen will involve more than the conventional three drugs (as is used for first time treatment of HIV+ patients).

So I am not surprised to see 5 antivirals in this regimen.

The use of three protease inhibitors together is somewhat unusual, but there have been recent studies suggesting that the addition of extra doses of ritonavir to boost the drug levels of the other PIs in the regimen can overcome some resistance to the PI class.

And finally, the interaction between fos-APV (Lexiva) and LPV/r (Kaletra) is complex; this may explain the use of extra ritonavir.

You were correct to call the physician to understand the regimen and the reasons for it, particularly if you were responsible in part for the ongoing administration of the drug, as in a hospital admission. Did you ask the patient? Often they will know how and why they are on their drugs...and often they will not.

What is my long-term prognosis?

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