Why is my doctor recommending Kaletra and Combivir to start?

Question

hi there. I tested positive 3 weeks ago and just got my intitial blood work results back. My CD4 is 284 and my viral load is 98,000. The doctor thinks i might have been infected for 3-5 years and has asked me to come back in 4 weeks to repeat the tests before starting treatment. He is suggesting Kaletra (2 tabs twice daily) and Combivir (1 tab twice daily). I have 2 questions - is this a good combination regimen ? and why so many tablets per day ? I hear of 1 tablet per day regiments . I am not co infected with anything else, but i do have slightly high cholesterol. Is he suggesting a large dose to try and rapidly increase my CD4 and decrease my V/L ?

Thanks very much

Answer

Hello, and thanks for posting.

Although the regimen of Kaletra and Combivir is still listed as one of the preferred regimens in the DHHS treatment guidelines, there are better options.

Kaletra is a protease inhibitor combination of ritonavir and lopinavir and is dosed twice daily. It has a long track record, but has more side effects than the combination of ritonavir (Norvir) and atazanavir (Reyataz) and most experienced HIV doctors would use this instead.

Combivir is a combination of AZT and Epivir and has more side effects and does not work as well as Truvada (Viread and Emtriva). So again, there is a better choice available.

In general, NNRTI-based regimens are more effective than protease inhibitor-based treatment. So Atripla (Viread, Emtriva, and Sustiva in combination) one tablet nightly is hard to beat. I would discuss this option with your doctor and see if he still wants to stick to this outmoded cocktail. If so, let us know why.

Good luck!