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Worried about Nelfinavir Resistance
Jul 30, 2001

Hi, and firstly congratulations on one of the most informative and helpful HIV sites on the net. OK, my question is about developing resistance to Nelfinavir. I started my first combo 11.5 months ago and it is Videx EC, Zerit, Viracept (Nelfinavir) and Sustiva. It has worked really well and my VL went from 139,000 to undetecable and CD4 from 350 to 950 within 6 months. I really want to keep it that way. I have no probs with adherence to Videx, Sustiva and Zerit (beepers & pill boxes being the trick here)but I have a real problem with Viracept as it is food dependent and I am not always in a position to eat when it is due. This is especially apparent at the weekends when, due to a very heavy weekly workload I may sleep thru doses and sometimes am up to 3-4 hours late with it. My doc says it seem to be doing me no harm but I cant help worrying. I seem to be doing so well on this combo that I would hate to change it. Would it be better to take Viracept on and empty stomach and be on time with it, or delay it to wait for food?? And what are my chances of developing resistance if this continues? Your advice greatly appreciated. PS No side effects whatsoever other than very controllable diarrhoea - thanks all the way from Dublin, Ireland

Response from Dr. Little

I am not clear whether you are taking nelfinavir twice a day or three times a day - if you are taking it twice a day, I personally am not a fan of this regimen. I do not think that the nelfinavir levels are as high as I would like using the drug only twice a day. I believe that there are multiple other choices which are better suited to a twice a day regimen than nelfinavir. If you are taking the nelfinavir three times a day, then I would support a change to a more convenient twice a day treatment option. Now that we have many twice a day regimens, I try to keep the treatments as simple and potent as possible with a twice a day regimen.

With regard to your question - it is probably better to take Viracept (nelfinavir) on an empty stomach rather than not at all - however, it is better absorbed with a meal (even a small snack) which contains some fat content. Overall, however, without your complete medical record - my advice is that any time a patient complains to me that they are missing doses or not following the appropriate dosing scheme, I take this very seriously. It sounds like you have many other options which might work out better with your schedule. I cannot tell you that your are about to "blow" nelfinavir, what I can tell you is that there are many other choices which may minimize your long term risks of developing drug resistance. I would sit down with your doctor and try to discuss what the other options include - perhaps he/she will understand that you are only trying to preserve the greatest number of long term options for yourself and are motivated by a desire to take all of your drugs correctly and minimize the chances of developing drug resistance.

Time to change?
sustiva/combivir missed dose

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