Dr. Gallant, I have been HIV+ for eight years now. I have been on some form of anti viral for most of those years. The lowest my viral load has ever been is 24000. I am currently on AZT, Viramune, Crixivan ,3TC, and after testing a 150000 viral load yesterday, my doctor suggested adding Invirase. I am increasing the dosage of Invirase gradually to avoid any toxic reaction. Am I doing the right thing by adding the second protease inhibitor? I feel the liver and kidneys could only tolerate so much. THANK YOU PS. I have a great Dr. but I respect your opinion

I haven't seen any data on using the combination of Crixivan (indinavir) and Invirase (saquinavir), though I believe such studies are planned. The combination that HAS been studied is Norvir (ritonavir) and Invirase. If one were to combine the two you mentioned, I'm not sure what doses you would use, but your doctor may be aware of some data that I haven't heard about.

Remember also that when combining Viramune (nevirapine) with Crixivan, you have to increase the dose of Crixivan to 1000 mg every eight hours because Viramune lowers Crixivan levels.

We don't know what to do with people who become resistant to Crixivan. As I have said before, I sometimes have success switching to Norvir and Invirase, but that doesn't always work because of the cross-resistance among protease inhibitors.