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undetectable on crix for one year |
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Question:What are your thoughts on switching from crixivan to viracept? i have been undetectable for one year on crixivan with either 3tc+ azt or 3tx+ d4t... it is my understanding that switching/stopping crixivan while viral load is undetectable would allow me to go back to crixivan with out mutations..this seems odd since missing a a few doses of crix can provide a mutation. is this a sound clinical course of action to take, i.e.stop crix, take viracept and then go back to crix when viracept no longer works? the patients i see on viracept have NO results...but they have blown through all other protease...seems odd since viracept is allegedly so powerful. i look forward to your response. thanksDr. Pavia's Response:The theoretic advantage of switching to nelfinavir (viracept) is that if you have no other protease resistance mutations and you develop nelfinavir resistant virus, it will likely still respond to indinavir (crixivan). It is clearly an easier drug to take.Here's the rub. If you have started to develop resistance to crixivan with mutations in the protease gene, all bets are off, since you are not sure whether the virus will follow the same pathway. If you have been undetectable for a year, it is not likely you have resistant virus, but with no virus in your plasma, you cannot sequence the virus, even if you wanted to pay the enormous cost. Bottom line is, we can't give you a clear answer. If Crixivan is difficult for you, it may be very reasonable to switch to nelfinavir. Otherwise, its a gamble, although a reasonable one. Good luck Andrew T. Pavia, MD |
