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A good combination?

Mar 28, 2004

Is Viread plus ddI plus Sustiva a good combination? I'm sensitive to these three but resistant to AZT and 3TC. I take Viread, Sustiva, and Kaletra now with VL less than 50, but I am growing wary of the high triglycerides, cholesterol and now possible glucose intolerance. I was wondering if it would be wise for the substitution of ddI for Kaletra. Thanks. Terry

Response from Dr. Boyle

It is tough to make treatment suggestions without knowing a lot more about your history and resistance testing, but I will give you some general impressions and suggestions. Viread + Videx (ddI) + Sustiva is an excellent once-daily choice, so long as the Videx is appropriately adjusted to reflect the increased levels that result when it is given with Viread. As far as your switching to that combination, I would be cautious about doing that. Since you have resistance to AZT + 3TC, it is possible that Videx is not fully active and that for you that regimen may not be effective or durable. This will depend somewhat upon the number of AZT mutations you have, so you should discuss this with your doctor. If Videx is not a viable choice, and you are having problems with the Kaletra, you might consider switching to a protease inhibitor with lower pill burden and better lipid and glucose profiles such as atazanavir, but atazanavir must be boosted with 100mg of ritonavir if given with Sustiva (efavirenz) or Viread (tenofovir) and it is unclear what adjustments should be made if it is given with both those drugs. Another choice for simplification is fosamprenavir, which can decrease the pill burden a little, although this is not quite as forgiving regarding lipids as atazanavir.

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