Aug 22, 2001
my current meds are amprenivir 1,250 mg twice daily, 200 mg norvir twice daily and combivir. My viral load is 11k am I am resistant to all current drugs. I am getting lipoatrophy and I have read that the dose for amp/norivir combo s/be much lower 750 amp.200 nor. is it unreasonable to reduce my dose to prevent further atrophy-since even at this high dose I am still detectable. I am very concerned I will become disfigured-from such a high dose of these meds
Response from Dr. Boyle
There are a lot of issues besides amprenavir (Agenerase) dosing in your question and there are some of holes in the information provided (for example, your past and present CD4+ T cell counts), but, I'll try to give you some general answers. First, given your detectable viral load and your progressive lipodystrophy on your current therapy, you and your doctor should evaluate the benefit you are getting from the therapy you are taking. For example, has your viral load been significantly decreased or are you maintaining immunologic benefit (an increased CD4+ T cell count) on the therapy? If not, consideration should be given to discontinuation of your current treatment and treatment with another, potentially more effective, regimen. Avoidance of lipodystrophy should certainly be a consideration in deciding on any future antiretroviral regimens. Second, the cause of lipodystrophy remains elusive but it appears that protease inhibitors (PIs) may be involved, directly or indirectly. To further cloud an already uncertain picture, it is not clear that if PIs are involved that it is a dose-related phenomenon. Still, I agree with your concern and I think that it is reasonable to consider adjusting your amprenavir dose depending upon your genotype/phenotype results. You should discuss this with your doctor since he or she may be using these high doses of amprenavir and ritonavir in an effort to raise your amprenavir levels to high enough levels to overcome viral resistance already present. The dose of amprenavir and ritonavir in patients without PI resistance is generally 600/100 or 750/100 (although there has recently been some data presented that raised concerns regarding amprenavir increasing ritonavir metabolism and indicated that perhaps that dose of rionavir may be inadequate), but in patients with some resistance the desired dosing may be different. As with all medications, this comes down to a balance of side effects (for example, lipodystrophy) against benefit, and its something about which you need to have a discussion with your doctor. The points raised above should be specifically addressed by your doctor during that conversation. Good luck.
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