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Need Advice on Switching from Kaletra to Invirase

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Lou-ah-vull:
Last week, I had my annual lipids profile done by my regular internist and it came back with greatly elevated triglycerides (from 168 to 480) and total cholesterol (from 150 to 224).  My HDL has always been low, but had moved up slightly from 33 to 37 and my LDL was up slightly from 86 to 91.  I had been controlling triglycerides (which run in my family) for the past two years with TriCor.  My doctor wrote me a script for Zocor, not understanding that it cannot be taken with the Kaletra I already take.  In addition, I have gained about six pounds since mid-May almost all in my midesection, despite no real dietary changes and maintaining a fairly active exercise program.

I had these results sent to my ID doctor and today he called me.  He is fairly certain my lipids have been raised due to my HIV meds which I started in mid-May.  He says the most likely culprit is the Kaletra, although the Combivir cannot be ruled out.  He says he doesn't like to deal with a side effect (raised lipids) with drugs, but rather we should look at replacing my PI with one less likely to raise lipids.  He is recommending unboosted Invirase (apparently the boosted version likely creates the same lipid problem as the Kaletra.)  He has had patients experience success in controlling their viral load with unboosted Invirase.  He also mentioned Reyataz, but says there is such a higher risk of jaundice that he would rather me try the Invirase. 

Here is the question (I bet you thought I would never get to it):  He recommended waiting for my monthly scrip for Kaletra to run out (approximately August 12) and then starting on Invirase.  He says there can be significant "gut" effects and he wants to see if I can tolerate it.  To save me money, he has given me a one month supply of the Invirase.  As many of you know, I am attending AMG in Montreal starting on Aug. 18.  I don't think I want to be experimenting with a new drug and possible nasty side effects while we are together.  I only pay $30 a month for my Kaletra (I would feel differently if I paid full market price), so I am willing to stop it sooner.  How far in advance of my departure for Montreal would you guys recommend me starting the Invirase to see if I can tolerate it?

Also, if anyone has had any experience with this PI and has some wisdom to share, I would appreciate it.  I have read the information on this website and at The Body website already.  Thank you for making it through this lengthy post... I will appreciate any advice and suggestions you may have.  I am really looking forward to the Montreal trip and I would rather know if I can tolerate this new drug before I leave.

If I have left out some important detail, please let me know.

Gary   :-*

gerry:
Gary:

I suggest that you hold on to that prescription and talk to your doctor again.  Unboosted Invirase is not recommended anymore because in the absence of Norvir boosting, it is very difficult to achieve and maintain adequate levels of Invirase in the blood.  Between that recommendation and the Kaletra, I would suggest that you stay on the Kaletra until you get clarification.  Your lipid levels, although high, are not to the point that you need to give up the Kaletra immediately.  If your doc insists on using unboosted Invirase, I would suggest that you get a second opinion.  As far as lipids go, Reyataz (boosted or unboosted) is a better option.  But effects on lipids aside, I'm very bothered by this recommendation of using unboosted Invirase.

Gerry

P.S.  Here's the Invirase prescribing info: http://www.rocheusa.com/products/invirase/pi.pdf

Lou-ah-vull:
I continue to read more about Invirase and it almost always speaks about boosting with Norvir.  It would be helpful to know if I am risking resistance if the Invirase alone does not stay in sufficient supply in the bloodstream.  Does anyone have any experience with this?

Also, if this should be posted in a different forum...I would probably  need some guidance as well.

I am especially concerned about timing a new drug so that I can travel to Montreal AMG with some confidence.

Gary

The Canuck:
Gary,

I don't know much about Invirase but think Reyataz / boosted with Norvir is a better switch ( I switched because of lipids problems related to Kaletra ). In my case Reyataz was easy on the gut ( didn't have any problems from day one when I switched ) and my lipids went back to normal.


--- Quote ---He also mentioned Reyataz, but says there is such a higher risk of jaundice that he would rather me try the Invirase.
--- End quote ---


I know there's a higher risk of jaundice with Reyataz but it doesn't affect everyone. In my case nothing turned yellow..perhaps my brain did but can't verified that.  :D

Regards,

The Canuck

newt:
I second everything Gerry says. Invirase is not recommended for use without Norvir.  Boosted Invirase is likely to repeat the problems you get from Kaletra on lipids. 

The PI friendliest to lipids is Reyataz, which is approved for use boosted and unboosted, but, me, I'd try it boosted first, because there's less chance of resistance and this is the recommended way for people who have taken HIV treatment before to use this drug - going unboosted if your lipids don't fall would be an option to think about, but would not be the only option for lipid management.

- matt

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