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Possible Dramatric Change
Dec 3, 2001

I'm currently on Abacavir, Invirase, Norvir, Tenofovir, and Videx since June, 2001 to present. On October 17, 2001 I was add on T-20, were my low CD-4 was 67 and VL was 173K since June, 2001 and currently my CD-4 is 335 and VL 400. If that's possible I need to continue with this same regimen, or that's possible I can't withdraw with agreement with my MD for one PI's at least Invirase or what will implications became for withdraw this meds???

Thanks

Response from Dr. Young

Thank you for your question.

It would appear that you have had a very good response to treatment. I would wonder if this is due to the simultaneous use of T20 with tenofovir (along with the potent NRTI/PI combo).

The first question I would ask is: Is the increase in CD4 count and viral load sustained? I would certainly repeat the testing to confirm the first set of labs. If the trend continues, I would be inclined to try to stay on treatment for at least the short term.

As to your question about withdrawal of Inverase, it might seem that the most onerous of your current medications is the proteast inhibitors. Is this because of side effects? Is this because of pill burden? If it is the former, then one should make sure that you are taking the meds with meals (decreases side effects, usually). There might be options for dual- or boosted PIs that might have fewer side effects (such as Kaletra, or ritonavir-boosted indinavir, amprenavir).

If the pill burden or pill size is problematic, Kaletra (ritonavir-lopinavir)or boosted indinavir might be a little better, though not dramatically lower pill burden.

Lastly, I would try to get the viral load below limit of detection (if possible) before making a switch. This has been suggested to get improved responses.

Hope this is helpful, good luck. BY



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