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Heard that Viracept is Garbage.
Aug 23, 2003

Dr. Cal,

I heard from the grapevine that viracept and crixavan is garbage? What are your thoughts.

Winston

Response from Dr. Cohen

Well Winston - that's just a bit harsh... since a lot of people did very well on both of these agents over the years.

However - perhaps we can clarify the concern with these two drugs. Both were major advances at their time. When all we had were nonsuppressive combinations of two nucleosides - the first study of Crixivan showed dramatic success - we were able to control HIV replication for far longer than ever before - and as a result - many people had restored immune systems and were rescued from AIDS illnesses and death. Now - the drug is challenging to take compared to other options - three times a day with diet and hydration requirements.... and there are potential and real side effects like kidney stones and fat gain in the abdomen. So while it worked - there were limitations. And some of these limitations were improved upon with the arrival of Viracept.

When viracept was launched - it rapidly became a very popular drug. It was relatively easy - initially just 5 tabs twice a day with food compared to the other PIs which were harder. It had diarrhea -- but no nausea and minimal other tox stuff to get in the way - again, better than what else we had. And it worked pretty well overall... plus if it didn't there was some info to support that at least some of the viruses that emerged could usually (but not always) be recontrolled with other PIs. But the limitations of its success became evident in studies done in the past few years - since in comparison to the "boosted" PI Kaletra, and the nonnuke Efavirenz - Viracept was not as successful in controlling HIV. And the higher viral rebound rate led some if not all clinicians gravitate towards the most successful options - especially since it seemed that people could tolerate these more potent options about as well as they could tolerate Viracept. Plus - while Viracept-resistant virus could be recontrolled most of the time - the story with using boosted PIs is that we see actually NO mutations at rebound - a more attractive outcome than even a story of mutations that can often be resuppressed.

So the meds that came before our current options were advances at the time - but just not as good as other alternatives using these criteria. And since we keep evolving - it is hopeful that in these next years - we'll continue to identify drugs that make the current crop something that we can look upon as stepping stones to even more successful treatment. But clearly that won't make the current meds equal to refuse - just another in a series of evoluations...

OK?



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