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Crixivan not very user friendly!
Oct 28, 1996

My question is, why would a company develope a drug soley on the basis of its efficasy against HIV? I am refering to the fact that the very things you must do to comply with the proper working mecanisms of this drug are very counter productive. Here are just a few examples. POW's major problem is maintaining weight. The first thing in any weight loss program is to increase fluids to flush fat cells. Crixivan makes you drink 1.5 liters a day. The dosing schedule makes it imposible to eat frequently enough. The major side affect of the drug is nausea and reflux. This makes it again very difficult to eat. What are we to do?

Response from Dr. Gallant

I would disagree with a few of your points. First, maintaining weight is NOT the major problem for people with AIDS. Weight loss is a symptom of a much larger problem: a high viral load leading to a deteriorating immune system. If you take care of the underlying problem, the weight loss will usually take care of itself. Second, nausea and reflux can occur with indinavir (Crixivan) but they are not very common in my experience.

Now, I will agree with you on your second point: indinavir can be an inconvenient medication for many people because of it's relatively complicated dosing schedule. I have many patients who have no problem with that schedule, and they have put on plenty of weight because they're healthier on Crixivan. I also have other patients for whom the schedule really gets in the way. For that second group, ritonavir may be a better alternative: it has some unpleasant side effects in the first few weeks, but after that, it's a little easier than indinavir because it's taken twice daily with meals.

As for why a drug company would make such a drug, all I can say is that for the people who have watched their T-cells climb, their viral load fall, and their health improve on Crixivan, I don't think there would be any question or debate. If you waited to release a drug until you had a perfect once-daily tablet with no side-effects, you'd wait a long time, and a lot of people wouldn't live to see the benefits.



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