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norvir + invirase the best posology ?

Jan 2, 1997

I have been receiving HIV treatment for 3 years now. After using DDI and retrovir for a year an a half, I stopped regimen for a while because I got a lymphom (non hogdkin). Then since july I take D4T and 3TC. But now my T4 are quite low 90 an d viral load is increasing again from 9000 to 35000 last month. So my beloved doctor asked me to switch to anti- protease. Furthermore he suggested to knock down th evirus with a four component cocktail. retrovir again , 3TC (nepivir), Norvir and saquinavir. I aggree with that, but i am a little concern with the posology. He suggested 500mg Norvir and 400mg saquinavir twice a day. I read in some articles that 400 + 400 was better than 600 + 600. I In 600 + 600 combination the virus tends to mutate. Could you give me some informations about the best posology for that combination. Thanks a lot PS excuse me for my bad english

Response from Dr. Cohen

I had to look up the word "posology" because it is not commonly used in English. I learned that it is the science of dosing. So thank you for contributing to my education. Now for your question . . .

I like your doctor's approach very much. The correct dose for saquinavir (Invirase) when given in combination with ritonavir (Norvir) is 400 mg twice daily. As for the "posology" of ritonavir, either 400 mg or 600 mg twice daily is acceptable. So far studies show that 400 mg is as effective as 600 mg, though long-term follow-up data are not available. I tend to favor 600 mg because we know that it is a therapeutic dose of ritonavir. However, if patients really have trouble tolerating that dose after giving it a good try, I feel comfortable letting them lower the dose to 400 or 500 mg twice daily.

It wouldn't make sense that there would be more mutation with the higher doses, unless it was because people weren't taking them due to side effects.

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