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protease inhibitors and hepatitis carriers
Jul 1, 1997

Dr. Gallant please excuse me if you have answered this question but I am new to this web site. I am presently taking Norvir, Invirase, AZT, 3TC and Zerit. I have been HIV since 1992 and been mostly asymptomatic. My last Cd-4 count was 370 and my viral load was around 5000. I had been taking the invirase, AZT and 3TC for about 3 months when these blood tests were taken. My doctor added the Norvir and Zerit which I have been taking for one month. I am concerned because I read that Norvir can cause probelms to hepatitis carriers. I had hepatitis 5 years ago and I am a carrier. Which of the protease inhibitors do you feel arethe least harmful to liver and also to I need to be taking all thress AZT,3TC and Zerit. I have been taking AZT for 3 years. Thank you.

Response from Dr. Gallant

Any protease inhibitor can cause liver problems in people who have chronic hepatitis, and this appears to be especially true when you're taking two protease inhibitors (usually ritonavir/saquinavir). However, that's no reason for you not to take the combination you're on, which should be quite effective. You don't need to worry about liver toxicity unless it happens. As long as you're getting your liver function tests checked periodically, you should be fine.

I should add that Zerit can also abnormalities in liver function tests. Your final question--whether you really need all five drugs-- is a tough one. I like the Norvir, Invirase, and Zerit-- the Norvir and Zerit were added most recently, so there is the lowest likelihood of resistance with those two drugs. The Invirase is likely to be much more effective now that Norvir has been added, provided you hadn't developed resistance beforehand.

The AZT and 3TC might be more optional. There is evidence for antagonism between AZT and Zerit, and it has been recommended that the two not be used together. 3TC is relatively harmless, but you might have developed resistance to it in the 3 months that you were on it. On the other hand, if your next viral load comes back undetectable, you could make a case for not changing a combination that works.

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