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switching from Crixivan to Kaletra
Oct 17, 2001

Hi: I was on Crixivan and Combivir for over 4 years and responded very well with no negative side effects. My viral load broke through in the spring and tests show high level resistance to all those drugs. My doc has put me on Kaletra and Sustiva (and abacavir/3TC/ddI). I understand the rationale behind the Sustiva but not the others. Does not Kaletra share several resistance mutations with Crixivan, and abacavir with AZT. ??? (I cannot tolerate d4T and the ddi is being recycled since I still have partial sensitivity). Is this the best possible combo in my situation? Thanks

Response from Dr. Little

In fact, Kaletra has the best profile of activity against virus with complete or partial resistance to other Protease inhibitors of all of the drugs in the PI class. I think that Kaletra is a very reasonable choice. Regarding the other drugs, given that there are a limited number of antiretroviral choices (all essentially within 3 different classes of drugs), it becomes necessary very quickly to recycle drugs to which you may have partial sensitivity once you have failed one or more drug in a certain class.

Given that you may have at least some PI resistance and some nucleoside resistance, the sustiva is a very good bet and is balanced by adding in drugs from both other classes. Having said this, I think that the choice selected for you sounds like a very reasonable regimen which is very likely to result in a good AND sustained virological response.


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