I have had hiv since 1988 and am resistant to everything (except for the new meds coming out). My t cell count is under 10. I take Kaletra, Truvada, smz/tmp, valtrex, and weekend zithromyacin.

My mouth has been very sore due to the thrush (it's full) and last week I had an upper endoscopy where they found thrush all along the esophagus. The problem is I am resistant to Diflucan (no dose works for me).

The only thing the doctor prescribed was Voriconazole, but the pharmacist wouldn't fill it as it has interactions with Kaletra, which apperently decreases the Vfend by 80%. I did get the prescription filled by another pharmacist, it was for 1 or 2 200mg tablets a day... would this be enough then after Kaletra decreases it? If not, do you know of any other possible treatment for me? Another physicial closer to me (my hiv doc is 3 hours away) thought of Amphotericin, but doesn't know how to get it (an iv drug that can be swallowed). I'd appreciate your opinion(s).

I suspect that the best thing that could happen to you would be to find a new highly effective antiretroviral regimen with new drugs. There is a chance that this would boost immune system so that it could help you to fight off the resistant yeast. In the interim, I would suggest that the best options for you are probably going to be voriconazole or amphotericin. The advantage of voriconazole is it can be given orally. The down side is the concern over drug interactions. One strategy might be to start the voriconazole with your current regimen and see if it helps. If it doesn't another consideration would be whether the Kaletra is actually doing you any good at this point in light of your low T cell count. Perhaps you might discuss with your provider the possibility of holding the Kaletra while you are on voriconazole in order to optimize its chances for success. If these strategies fail certainly a course of intravenous amphotericin would be a viable next step. An alternative to this, albeit more expensive would be a drug like caspofungin.

Best, Eric