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Meds with a busy schedule
Mar 17, 2007

Hello, So I received my last labs early February my CD4 was a little under 300 and my VL was 98,000 copies...I decided to start medicine this Spring and I will be taking Kaletra two pills twice a day and a Truvada. I'm 24 and in college and I take night classes on top of working full time. I go to school three days during the week and sometimes do not get back home until 11pm. I plan on taking my morning dose of two Kaletra and a Truvada around 7-8am before work. On school days I would like to take the second dose of Kalentra when I get home at 11, and on non school days take it abou 7pm or so. Do you think that would be okay or do you feel I maybe setting myself up for resistance or maybe taking the pills on school days too late in the evening? I'm kind of confused about this...thanks

Adam

Response from Dr. Sherer

The best initial strategy would be to take the medications every 12 hours, as recommended, even on the days when you are at school. The tablet formulation of Kaletra requires no refrigeration, so some alternatives would be to bring a dose with you to school on those days and take them at the same time, e.g. 7-8pm with a snack.

To answer your question, this is a 'forgiving' regimen, in that it does very well in diverse patients, even when the timing of adherence is less than perfect, and my guess is that you would do OK with your plan. I prefer not to guess with answers to questions like these, however, and I don't think it would be too hard to figure out the way to accomplish 12 hour dosing on school days. If you are driving, you may be able to keep the medications discretely in a glove compartment, or in your book bag, etc.

I would also suggest that you talk to your doctor about taking this regimen once daily, i.e. all pills at the same time once daily in the morning. Two large studies have shown that the effectiveness of once daily Kaletra is the same as the twice daily for a person with your baseline CD4 cell count and viral load, and in those studies that patients in the once daily group only took their Kaletra once daily.

And still another strategy is to take the medications twice daily, as your doctor has suggested, for a few months in order to bring the viral load under control, and to see what the side effects are like with that dosing pattern. With the new tablet, the side effects are minimal, and with once daily dosing, the only difference seen was an increase - from 4 to 10% - of loose bowel movements.

So, after you have experienced the side effects, if any, and achieved a viral load below detection, i.e. in 2-6 months, then you and your doctor could choose to take the medications once daily in the morning. As I suggested above, I advise always taking this regimen with a meal or a snack.

Talk to your doctor about these suggestions and your concerns, because he or she may well have information that is important for you that I lack.


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