Dear Dr. Daar, I am a 50-year-old male who is 22-plus years positive. After 11 years, I switched this year from Crixivan to Reyataz with a Norvir boost. However I was also taking a PPI (Protonix) for severe acid reflux, but can't with Reyataz. I am considering switching to either Lexiva or Kaletra, because the gut issues are intolerable and Pepcid is only partially effective. The problem is my lipids are normal for the first time in a decade and I would hate to have that change. Any suggestions? Oh, Sustiva is not an option. I tried it. Thanks,

Mark

Thank you for your post.

You probably should consider being evaluated by a gastroenterologist to make sure that there are no other problems causing your discomfort or has resulted from your chronic reflux.

That aside, you are correct that you can't take a PPI with your reyataz. When considering a switch it is difficult for me to be definitive without knowing more about whether your viral load has been undetectable and/or remains that way and how signficant your increase in lipids had been in the past. Without this information I can only make general comments.

If you were to make a change I agree that one of the PIs you propose would be reasonable and allow you to take a PPI. I would suggest that you need not worry too much about lipids since everyone is different and you won't know how either of these agents effect your lipids until you try them. If it is too much then you can consider lipid lowering therapy or another change. If you have been undetetable on crixivan and tolerate Lexiva with ritonavir with undetectable virus but your lipids are too high you could even consider going with lexiva without ritonavir and see if that helps. The good news is that you do have many options and more on the way in the form of new investigational drugs. Nevertheless, you do need to be careful and discuss all of these issues in detail with your expert provider.

Best, Eric