Kaletra only

[suzieque]

Hi all,
     I wondered if anyone has had any experience or knowledge of using only Kaletra? My doctor mentioned that some of his patients have done this ( without his prior knowledge) with good results. I am going to see him tomorrow to change my meds again (dreaded lipoatrophy!!) and need to make a decision about what to take. I have had lipo on several drug combo's, am currently on Reyayaz ( ritonavir booster), epivir and tenofovir. I know, I know, it is supposed to be a good combo for not causing lipoatrophy but my doctor says since that he has seen it now with several people where tenofovir was the only possible cause. Any words of advice would be appreciated!! Thanks

[newt]

See these reports:

Lopinavir monotherapy: less potent than triple therapy with higher risk of resistance esp Simon Collins' comment at bottom of page

Resistance implications of monotherapy with lopinavir/r (Kaletra)

Resistance, this is your big concern here. 

Various studies show 60-80% of people maintaing undetectable viral load using Kaletra alone at 48 weeks.   These small-scale studies do not really have time to look at CNS drug penetration and sanctuary sites etc, which may be important in terms of developing resistance.  But viral load of less than 50 after a year using just Kaletra is interesting.  If this was a short-term effect, and resistance developed in sanctuary sites, you would expect to see some kind of viral rebound detectable in the blood by then.

Short version: The nukes are doing something, but for everyone?. No-one knows when it's okay to discard them for certain, or indeed if long-term PI monotherapy works, but it seems to work for the majority of people for at least a year.

Kaletra + 3TC or abacavir may be another (but, erm, completely untested) approach to a less-nuke combo.

- matt

[newt]

Having read your other post re: abacavir sensitibity, I reckon Kaletra + 3TC or FTC is a good discussion to have.  FTC seems better re: damage to cellular metabolism but is otherwise sister to 3TC.  It also has a loooooong half-life, so maybe a better option there (more consistent drug level at end of daily dose should reduce risk of M184V mutation, which is kinda big if the single nuke drug level falls too low). 

- matt

[suzieque]

Hi,
   Thanks again for your reply. Nice to know that someones listening! My doctor did mention Kaletra with just epivir...will let you know what he says tomorrow.