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Hydea vs. Kaletra
Feb 14, 2001

My doctor wants me to begin a five to six drug combo using Kaletra. I however want to know if it is more beneficial to be on a combo that include a PI? I recently ended a 7 month STI for unique reasons. My VL has just reached 50,000, CD4 is still strong and my VL was 5,000 before the STI. Previously I used a 4 drug combo of which three are the same drugs that I am currently taking without the Hydrea. Hydrea always seems to reduce the VL to below 10,000. I have always understood that a VL below 10,000 is fairly good considering the number of drugs i have taken and the number of years of infection. Not to mention I have a severe dislike for the PI's. Also, do you think that Kaletra will really help? Or is better than Hydea?

Thanks for your help.

Response from Dr. Pavia

It is hard enough to design a new regimen for someone when you know all of their history and labs, let alone to try and comment on specifics in the forum. I'll have to give you some general responses that I hope will help.

1. Yes, if you have a really extensive past exposure history, keeping the viral load a log (10 fold) below where it started is a helpful target. For you, that would be about 5,000. 10,000 copies also, in general correlates with more stable CD4 count and better clinical outcome. The key variable to watch is what happens to your T cells in a partially suppressive regimen - are they stable or rising.

2. Hydrea is still a bit of a mystery, although enthusiasm for it is fading at this point. It clearly can help further reduce viral load in experienced patients. It clearly has a cost in terms of lower overall CD4 counts than without it at a similar viral load, and an increased risk of neuropathy and pancreatitis. How the risk benefit plays out in any patient is an individual balance.

3. Kaletra is certainly a potent, well tolerated PI. By itself, in the abstract, it is considerably more potent than hydrea. However, like any new agent, it should not be added in a setting where it is the only new or active drug, since that is likely to waste its benefit. What I think you need to talk with your doctor about is how many of the drugs are likely to be active. Whether you need a new regimen now depends on your clinical condition and your CD4 count. If the new regimen is tenuous but your T cells are hihg, it may be worth waiting for Tenofovir or DAPD to help build a stronger backbone for the Kaletra.

Hope this helps, although I know it is not a direct answer.

ATP



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