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Oct 2, 2001

Dear Doctors, I have a question concerning my treatment. I have been on Invirase and Combivir since 1999, July. Fortunately my viral load is still below 50 copies. My doctor insists on switching to Fortovase as a better version of saquinavir. I am taking now Invirase three time daily 600 mg, totally 1800 per 24 hours. My doctor suggests not to encrease the doses of saquinavir when i switch to Fortavase, that means to continue taking Fortovase three times daily 600 mg. BUT I have read that the normal doses of Fortovase when given alone as protease inhibitor are three times daily 6 capsules (1200 mg), totally 3600mg per 24 hours or twice daily 8 capsules (1600 mg), totally 3200mg per 24 hours. My questions are: 1)Does my doctor have right about these lower doses of Fortovase in my case or I should take the standard doses of Fortovase? 2)Do you think that I should switch to Fortovase when my viral load is undetectable being on Invirase? 3)And which one of the two possible regimens of taking Fortovase is better - tree times or twice daily?

Thank you for being with us, Maria

Response from Dr. Pavia


You definitely should not stay on Invirase, in my opinion. The drug levels of saquinavir are generally so low that resistance is common, and resistance to saquinavir is not a good thing to have.

You have many choices. Since you did not mention any side effects, you may be very tolerant of saquinavir. I would only use Fortavase as full dose though. Since you have done well on the low exposure, the twice daily (1600 mg every 12h) choice should work and will be much easier. You might do equally well on nelfinavir (viracept) and it has the theoretical advantage that it is much easier to find a regimen that works after nelfinavir failure. It would even be reasonable to switch to a non nuke (nonnucleoside reverse transcriptase inhibitor) like nevirapine (viramune) or efavirenz (sustiva).

All are good choices, but staying on invirase is not, and I would be nervous about lower dose fortavase.

Good luck



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