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2YEARS OF CRIXI
Jul 13, 1998

I have been on Crixi,3TC and AZT for 2 years without any significant problems up to now. 1 week ago I suffered from a terrible pain (colitis) and I had to go to the hospital for one day (perfusion) and next I felt much better. I know that I have to drink a lot due to related kidneyproblems and I do drink at all times. Now yesterday the same pain returned.....do I have to conclude that one kidney is getting out of order? Is it possible to damage forever a kidney due to Crixi takings?What can be done except of drinkin water?Thank you for your assistance.

Response from Dr. Cohen

Well - it is not clear from your story if what happened to you was a kidney stone from Crix or not... and in order to know what to do you first must be sure you understand the problem. And you mention drinking enough water - but in the summer you might need even more than usual depending on where you live... And if untreated - a stone could possibly do kidney damage - so what can you do?

If you have now two episodes of kidney stones despite taking enough water - there are a few issues. One is that a report from Geneva suggested that the acid balance (pH) in the urine may help prevent the stones - so you might consider drinking more cranberry juice to acidify the urine to see if this works for you.

The other option that might work is to take a lower dose of Crixivan and add ritonavir -- this is an experimental approach that is justified based on observations done so far by Abbott that you can take less Crixivan and, with ritonavir's help, still maintain the target level of Crixivan that we believe is needed to maintain viral suppression. So far the one dose combination that has been used is 400 mg twice a day of both ritonavir and crixivan - and since the actual dose of crixivan is less - there is the expectation that you would have less problems with kidney stones as we guess that this is related to having a high initial blood level of crixivan. [Since ritonavir slows the metabolism of Crix down - you can still maintain the target level despite taking less.] Dr. Cassy Workman from Australia presented her work on a small number of patients taking this combination with two other antivirals and reported success - with the advantage that you can also take the Crix with food.

hope that helps.

CC



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