Question:
Hello, I am a 34 year old man first diagnosed with HIV on September
26th, 1988. I have been on varying medication regimens since that date,
but since 4/96 I have been on 3Tc, D4t & Indinavir. Latest t-cell
absolute count was 130 with a percentage of 10%. Viral load was 156,000
by bDNA. Prior to these counts, my viral load was somewhat higher at
462,162 copies/ml by HIV-PCR on 11/26/96. A recent appointment with my
doctor resulted in his suggestion that I stop taking the Indinavir &
3Tc, and replace them with Nelfinavir & DDI. But the way I read your
article, taking Nelfinavir after being on the Indinavir would be a
mistake -- or am I reading this the wrong way? I'd appreciate a reply
when you can -- I am waiting on my doctor to submit the paperwork to
Agouron for compassionate usage of the medication and would like to know
before the drug arrives.
Thank you very much for all of your help. PS -- My current diagnosis is
AIDS-related peripheral neuropathy with associated myelopathy.
Dr. Pavia's Response:
Based on studies of virus taken from people who are FAILING
ritonavir or indinavir, virus with high level resistance to these two
protease inhibitors (which requires the virus to accumulate 4 or more
changes in the protease enzyme) will likely be resistant to nelfinavir.
Therefore, if you initially responded to indinavir but are now breaking
through, we would guess that nelfinavir won't work. On the other hand,
for people who are responding well to ritonavir or indinavir but having
trouble with side effects or scheduling, substituting nelfinavir may
make self. It is always a good idea to change two or more drugs at once
if possible, so if you have never used ddI there is a reason to try it.
A word of caution though if you already have neuropathy, the combination
of ddI and D4T could make it worse. Bring this up with your doctor.
Good luck.
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