May 20, 2004
I have been switched to a new regimen involving Kaletra with Epivir and Viread. My previous regimen was Epivir, Viread, and Zerit which finally failed after 2 years dropping me to a cell count of 44 and VL of 185,000. I have now been taking the Kaletra since Mar 31, and my CD4 report went higher to 179 in 4 weeks. Today, I saw my HIV doctor and complained of my inability to tolerate Kaletra -- I have queasy stomach or stomach cramps, which lead to diarrhea and feel like my system is blowing up from the inside all the way up to my neck. Fortunately, I have not vomited from this yet, but always have this feeling. Do you have any suggestions, or have I not given this enough time to adjust to? My phenome resistance reports me totally resistant to any of the NNRTI's, and now sensitive to all the previously resistant PI's I was once resistant to 3 years ago. My doctor had some blood drawn to do a viral load, although she said it still may be a little early for a good indication. I know Dr. Henry has suggested Reyataz to someone who was also having trouble with Kaletra in the gut tolerance area. Thanks in advance for all your help.
| Response from Dr. Henry
The GI complaints seen with Kaletra sometimes improve further over the first several months. Immodium, Lomotil, calcium supplements, oat bran--all seem to help some patients with chronic Kaletra related diarrhea. Reyataz, Lexiva, Invirase, Crixivan-all can be taken with low dose ritonavir and can be tried as an alternative to Kaletra if the GI complainst dont't resolve (which drug depends on resistance status). I would worry about using a PI without ritonavir. KH
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