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switching nevirapine
Jul 21, 2007

hi there. I am on Truvada and nevirapine. doing fine, VL undetectable, and cd4 in the 450 range. This combo is doing fine, however, I want to give Kaletra a go. I hear it has been found to be more fat friendly than NNRTI's mainly sustiva. If this is the case, Nevirapine is pretty similar....so that's my non-medical professional reasoning. So, I have taken nevirapine once before and stopped for a few years, then started up again with this current combo. My question (finally:) is if the Kaletra does not work out, can I still go back to the old standby of nevirapine?

thanks

Response from Dr. Daar

Thank you for your post.

Let me answer your specific question first then make some general comments.

With regards to switching to Kaletra and if it doesn't work out going back to nevirapine. If you stop nevirapine while your viral load is undetectable then you will likely continue to have a virus susceptible to this drug in the future. Whether you will be able to go back to truvada with nevirapine will depend upon whether you develop resistance to tenofovir and/or FTC (components of truvada) in the interim. If you did you may need to use a new combination with nevirapine.

While it is certainly your decision as to whether to switch or not, I would encourage you to discuss this further with your provider. If you are tolerating your current regimen without side effects then it is very unlikely that you will develop fat problems in the future. You are correct that a very interesting recent study demonstrated less fat loss in those receiving kaletra than efavirenz the difference between the two, and the proportion that developed fat loss in both groups was very small when either of these drugs was combined with tenofovir and 3TC or FTC, which is what you are taking. There is something to be said for the old adage, "if it ain't broke, don't fix it."

Best, Eric


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