I've been on a Crixivan, Epivir, and Videx combo for the last 3.5 years -- it's worked great with very tolerable side effects. T4s remained between 600 and 800, viral load was undetectable for all these years. I've had at least 5 kidney stone episodes and my doctor asked me to drop Crix at the end of June because of my kidney function tests. I stopped everything not wanting to leave just the two weaker drugs. Blood work at the end of August was 425 T4 and a viral load of 54,000. We are investigating other drugs at this time. I'd like to stay w/Epivir and Videx and maybe try one of the Crivian/Norvir combo therapys. I've read that the Crix400 and Nor400 therapy really reduces the kidney problems associated with Crixivan and the Crix800 and Nor200 somewhat reduces those problems -- working just as well as the three 800 dose regimen. The only problems I had with Crix over the 3.5 years were kidney stones. Do you think it would be safe to try it again with one of these new combo doses? Or would I be risking further kidney damage? What really scares me is trying a totally different drug and dealing with the possible nastier sides effect. Any suggestions?

Juno in Texas

You've raised all of the relevant questions about indinavir and indinavir/ritonavir combinations. There are some reports that with ritonavir, the frequency of stones is lower than with conventionally-dosed indinavir. I don't think that there is any convincing data that one dosing scheme is better than another, regarding stones (but stay tuned).

There are several other reasonable alternatives to indinavir; you are right that each carries a new potential for side effects, though even a ritonavir-boosted indinavir regimen would have that too. It certainly is worth pursuing these alternatives with your doctor.

-BY

Benjamin Young, M.D., Ph.D.