|Triglycerides at 580
Oct 24, 2003
My Baseline Values are Viral Load 38,917 and CD4 26 and 4 beginning in September 2002. My regimen is Kaletra, Epivir, Viread, Acyclovir, as well as Lopid, Prinzide and Protonix. My October 2003 Viral Load is <50 and has been since February 2003. My CD4 is only at 40 and 8. The percentage has remained stable in the 7 to 10 range since November 2002. While I am worried that my CD4 is very low, I have a new worry and that is my triglycerides have gone from the 300s to 580 as of October 2003. My primary physician wants to switch me to Tricor and my Infectious Disease NP has suggested I might look into an Aids Clinical Trial Group at Indiana University (they would take me off the Lopid for at least a month and put me on Nyaspan. Meanwhile. I am being told by non-medical people to try MSM powder and large doses of Vitamins C and E. I tend to think the Tricor may be best as the Lopid seems to have lost its effectiveness. What do you think (and, any other comments re: regimen, etc.)?
Response from Dr. Conway
Your elevated triglyceride levels are often seen in patients on Kaletra. Further, it appears that the regimen is being very effective, in terms of virologic suppression. This is one of the key indications for a single drug substitution to address the triglycerides. There is EXCELLENT clinical trial data to support a switch of the Kaletra to either nevirapine or efavirenz. Further, a change to abacavir could also be considered as long as you did not receive a previous non-HAART regimen or had not experienced a virolgic breakthrough while on NRTIs. This switch would simplify your regimen in terms of pill count and would also allow you to take your HAART once a day. It would also avoid the polypharmacy that would be required to treat your triglycerides.
A change to atazanavir may accomplish the same thing. However, there would be the issue of a drug interaction with tenofovir that would require a boosting of the atazanavir with ritonavir, which leaves you on a drug associated with high triglycerides.
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