Welcome, Guest. Please login or register.
March 28, 2024, 05:19:09 pm

Login with username, password and session length


Members
Stats
  • Total Posts: 772946
  • Total Topics: 66310
  • Online Today: 424
  • Online Ever: 5484
  • (June 18, 2021, 11:15:29 pm)
Users Online
Users: 1
Guests: 375
Total: 376

Welcome


Welcome to the POZ Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Do I Have HIV?” posting guidelines. Click here for posting guidelines pertaining to all other POZ community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Need Advice on Switching from Kaletra to Invirase  (Read 8547 times)

0 Members and 1 Guest are viewing this topic.

Offline Lou-ah-vull

  • Member
  • Posts: 1,029
Need Advice on Switching from Kaletra to Invirase
« on: July 26, 2006, 12:27:28 am »
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   :-*

Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
05/06:  Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), UD
02/07:  Switched to Atripla 2/8/07
04/07:  566 (37.7%), UD
08/07:  761 (42.3%), UD
06/08:  659 (47.1%), UD
01/09:  613 (43.8%), UD
07/09:  616 (47.4%), UD
01/10:  530 (44.2%), UD
07/10:  636 (48.9%), UD
01/11:  627 (48.2%), UD
07/11:  840 (52.5%), UD
01/12:  920 (51.1%), UD
07/12:  857 (50.4%), 40
10/12:  UD
01/13:  710 (47.3%), UD
07/13:  886 (49.2%), UD
01/14:  985 (46.9%), UD
06/14:  823 (47.2%), UD
01/15: 1366 (45.2%), UD
07/15: 1134 (50.7%), UD
02/16: 1043 (55.1%), UD
08/16:  746  (55.4%), UD
08/16:  Switch from Atripla to Genvoya

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #1 on: July 26, 2006, 12:38:11 am »
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
« Last Edit: July 26, 2006, 12:54:03 am by gerry »

Offline Lou-ah-vull

  • Member
  • Posts: 1,029
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #2 on: July 26, 2006, 04:24:02 pm »
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
Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
05/06:  Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), UD
02/07:  Switched to Atripla 2/8/07
04/07:  566 (37.7%), UD
08/07:  761 (42.3%), UD
06/08:  659 (47.1%), UD
01/09:  613 (43.8%), UD
07/09:  616 (47.4%), UD
01/10:  530 (44.2%), UD
07/10:  636 (48.9%), UD
01/11:  627 (48.2%), UD
07/11:  840 (52.5%), UD
01/12:  920 (51.1%), UD
07/12:  857 (50.4%), 40
10/12:  UD
01/13:  710 (47.3%), UD
07/13:  886 (49.2%), UD
01/14:  985 (46.9%), UD
06/14:  823 (47.2%), UD
01/15: 1366 (45.2%), UD
07/15: 1134 (50.7%), UD
02/16: 1043 (55.1%), UD
08/16:  746  (55.4%), UD
08/16:  Switch from Atripla to Genvoya

Offline The Canuck

  • Member
  • Posts: 628
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #3 on: July 26, 2006, 04:35:24 pm »
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.


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

Offline newt

  • Member
  • Posts: 3,900
  • the one and original newt
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #4 on: July 26, 2006, 05:09:59 pm »
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
"The object is to be a well patient, not a good patient"

Offline whizzer

  • Member
  • Posts: 392
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #5 on: July 26, 2006, 08:17:12 pm »
I currently take Invirase boosted with Norvir - 1000mg SQVwith 100mg RTV twice a day.   I have been taking this for 6 months.  No sides to speak of, other than the occasional loose stool.  My lipids remain normal.

Invirase is poorly absorbed, at about 4-6%, and must be taken with a full nutritious meal, not just a snack.  It has the potential to raise lipid levels, though some say not to the same extent as Kaletra.   Boosted Invirase has been shown to raise lipid levels an average of 10% above baseline.   Unboosted, you would have to take a lot of it and more frequently than twice a day.  This will undoubtedly increase the likelihood  of side effects and you will also have the inconvenience of having to eat in order to take it.  Add to that the fact that unboosted Invirase is no longer recommended due to the poor absorption/short half life and you have big reasons to avoid this PI if you do not boost it with Norvir.  In fact, almost every source I've seen insists that Invirase MUST be boosted with Norvir.

Here's a link to a Drug Resistance cohort study.  Note the "startlingly high" levels of resistance developing with the AZT/3TC/SQV (primarily unboosted Invirase).   http://www.retroconference.org/2004/cd/Abstract/689.htm

Reyataz has proven to be lipid-friendly so far.  Reyataz with Norvir is the preferred way to take it in the treatment experienced.  It does have the increased potential for jaundice, which Invirase does not seem to share.  How's your liver enzymes?  Are you at risk for jaundice?

If your VL is currently undetectable then you may be able to make the transition to Invirase without incident, but it will be a pain in the ass to take - not to mention flirting with resistance, as well as going against all conventional wisdom -  if you go the unboosted route. 

100mg Norvir twice a day is a pretty low dose.  It's only used to shut down the CYP 3A4 pathway in the liver, thus making the meds metabolized by this pathway hang around longer in your bloodstream.  At that low dose, it's antiviral effect is low, and so probably is the potential effect on lipids.

Personally, if your viremia is below 50 copies, I would try Invirase/Norvir.  I would avoid unboosted Invirase entirely.  I would strongly consider Reyataz/Norvir.  If your doc really thinks the Norvir is part of the problem, then I might consider unboosted Reyataz.

In any case, I wouldn't make any med changes until after your trip to Montreal.  You don't want to risk spending your time in Montreal on the toilet.

Just my two cents.  Hope it helps.

Of course, your doctor is far more conversant on this subject than me.  I would ask a bunch of questions, but I would place a high value on his opinion and clinical expertise.

-Whizzer

Offline aztecan

  • Member
  • Posts: 5,530
  • 36 years positive, 64 years a pain in the butt
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #6 on: July 26, 2006, 09:36:41 pm »
Hey Gary,

I was on the original Invirase back in 96. Mind you, they have since reformulated it and now use a Norvir boost to keep it at usable levels, but if the "gut" issues are anything like I experienced when I took it, I would hold off starting it until after Montreal.

From what I'm told, it is much easier to take these days.

Back then, when they called it Saquinovir, it had to be taken with a full fat-filled meal, plus with an 8oz. glass of grapefruit juice. Even with that, I experienced painful bloating (the kind that leaves your abdominal muscles sore because of the frequency and amount of gas you produce), plus it then segued into diarrhea from hell that was pretty much uncontrollable when combined with the bloating.

Like I said, they reformulated it, so it might not be nearly as bad these days. I know they now boost it because it has such a poor absorbsion rate. We didn't have anything boosted back when I took it, so maybe its better.

I think its definitely worth a chat with the doc about - and not something I would want to start when I was planning a trip. Your lipids don't look that bad yet. It is doubtful switching after you get back would be any real health concern.

Just my 2¢ worth.

HUGS,

Mark
« Last Edit: July 26, 2006, 09:45:50 pm by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #7 on: July 26, 2006, 11:44:46 pm »
Quote
It would be helpful to know if I am risking resistance if the Invirase alone does not stay in sufficient supply in the bloodstream.
Yes. (see the reference posted by Whizzer). Invirase should not be used nowadays without Norvir boosting.  Switching you from Kaletra/Combivir to unboosted Invirase/Combivir is really like putting you on one of the very early HAART regimens (circa late 90's), some of which we now know in retrospect were not good combinations to use.  It's almost like ignoring all the knowledge that was gained over the past decade about protease inhibitor pharmacology.  Out of curiosity, what dose of unboosted Invirase were you prescribed to take?

Offline Lou-ah-vull

  • Member
  • Posts: 1,029
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #8 on: July 27, 2006, 02:16:13 am »
500 mg, 2x a day.  He gave me a 30 day supply, but wanted me to wait until I finished my Kaletra (which would be around Aug 12.)  I am really nervous about this now that I have read some things and have looked at all your posts.  I am going to speak with him again to let him know about what I have read. 

He told me he  has patients that can absorb the invirase without the booster.  In my case though, it sounds like I run the risk of resistance.  I would not test for VL, CD4 and lipids until late September.  Of course, I am the one at risk...not the doctor.  So, I am going to tell him that I don't have the confidence to do this yet.  He also does not know that I intend to leave for vacation (AMG Montreal) on Aug 18.  I will tell him that too, and that it may not be good for me to experiment with my regimen until I return. 

This advice has been helpful and it corroberates my research.  As long as I am this uneasy, I am not confident to make the change.  I hope everyone will keep helping me with advice.  This is the first real complication I have faced, and with the doctor suggesting something unusual, it is scary.

Gary
Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
05/06:  Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), UD
02/07:  Switched to Atripla 2/8/07
04/07:  566 (37.7%), UD
08/07:  761 (42.3%), UD
06/08:  659 (47.1%), UD
01/09:  613 (43.8%), UD
07/09:  616 (47.4%), UD
01/10:  530 (44.2%), UD
07/10:  636 (48.9%), UD
01/11:  627 (48.2%), UD
07/11:  840 (52.5%), UD
01/12:  920 (51.1%), UD
07/12:  857 (50.4%), 40
10/12:  UD
01/13:  710 (47.3%), UD
07/13:  886 (49.2%), UD
01/14:  985 (46.9%), UD
06/14:  823 (47.2%), UD
01/15: 1366 (45.2%), UD
07/15: 1134 (50.7%), UD
02/16: 1043 (55.1%), UD
08/16:  746  (55.4%), UD
08/16:  Switch from Atripla to Genvoya

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #9 on: July 27, 2006, 04:10:17 am »
Then what you got was the new Invirase tablets.  He probably meant for you to take 500 mg 2 tablets twice a day, which is the correct dose WHEN it is combined with 100 mg Norvir twice a day.  This new formulation was FDA-approved for use in HIV only in combination with Norvir: U.S. FDA APPROVES NEW 500 MG TABLET FORMULATION OF INVIRASE  It's never meant to be used without Norvir and if your doc is using it unboosted, then there is something really wrong about that.  Also, saying that he has "patients that can absorb Invirase without a booster" is a pretty scary statement because that means he is using it in a sort of "experimental" and "unproven" manner.  Not that docs have not used drugs off-label, but in this situation, there is cause to be concerned.

A little history on saquinavir, the active ingredient in Invirase: when it got approved as one of the earliest PIs, it was in a hard-gel capsule form (Invirase) taken as 3 pills every 8 hours.  Mark mentioned having to take it with grapefruit juice and a fatty meal to try to increase its absorption.  But even with all these maneuvers, it was still difficult to achieve adequate enough blood levels of the drug.  The soft-gel capsule form of saquinavir (Fortovase) then came along and basically replaced the hard gel capsule because it was absorbed better.  The dose was something like 1200 mg every 8 hours.  Unfortunately, it produced more gastrointestinal (GI) side effects.  When Norvir boosting became commonplace, it was first tried with the soft-gel capsules which were still being used.  The Norvir boosting worked well in achieving good blood levels and reducing the dose of saquinavir to just 1000 mg twice a day (there were other doses that were tested, all lower and less frequent than the original three-times-a-day dose).  The problem was it still caused a lot of GI side effects causing some patients to give up on it.  When this was tried with the older hard-gel capsules, they found that they could still use the 1000 mg twice a day and achieve the same blood levels with Norvir boosting and there was less GI side effects.  So that became the norm and the soft-gel capsule Fortovase was retired.  Along came the new 500 mg tablet formulation with allowed for even less pills to be taken (2 tablets twice a day with Norvir, compared to 5 200mg-pills twice a day of the old hard gel Invirase with Norvir).  Both formulations were found to achieve the same levels of saquinavir in the blood, but ONLY when taken with Norvir.

So I guess what I'm saying is it is NOT OK for the doc to recommend you taking two 500-mg Invirase tablets twice a day without Norvir and you need to question the wisdom behind it.  This is an incorrect and dangerous way to use this drug that is not backed by scientific data.  DON'T SWITCH to this until you get all your questions answered (and when you do get all your questions answered, I doubt that you would agree to switch to unboosted Invirase).  You may want to post your question at the Hopkins website if you want to get an expert opinion.  Dr. Galant usually responds pretty quickly within a day or two.
« Last Edit: July 27, 2006, 04:34:37 am by gerry »

Offline Tim Horn

  • Member
  • Posts: 797
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #10 on: July 27, 2006, 06:27:39 am »
Gary:

I can't echo Gerry's words strongly enough. 

You should not take Invirase unboosted with Norvir.  This isn't just a suggestion -- it is a recommendation.  Both the Department of Health and Human Service's antiretroviral treatment guidelines -- and the FDA -- recommend (require would be more like it) that Invirase be boosted with Norvir.  In fact, the FDA has indicated in no uncertain terms that Invirase is ONLY to be used with low-dose Norvir for the reasons that Gerry reviews above.  The correct dose of Invirase is two 500 mg tablets PLUS one 100 mg Norvir capsule, both twice a day.

Your doctor told you that he has patients who are absorbing the Invirase without the Norvir booster?  And how, on earth, did he make this determination?  The only way to know this is to order therapeutic drug monitoring -- and I haven't seen any data suggesting that some patients are absorbing Invirase well enough, without Norvir, to acheive maximal and durable viral load reductions.  Did your doctor specifically mention therapeutic drug monitoring to check your Invirase levels after starting it without Norvir?  Doesn't sound as if he did. 

I apologize for being blunt, but the fact that your doctor is more concerned about the possibility of juandice associated with Reyataz (which, by the way, is believed to be purely cosmetic; it does not indicate underlying damage to the liver) than he is about the risks associated with using unboosted Norvir, I think there's a problem.  Not only do I think it wise to rethink the advice you've received from your doctor, I think it's a good idea for you to seek out a second opinion in this regard. 

Tim Horn

 
« Last Edit: July 27, 2006, 06:33:02 am by Tim Horn »

Offline Robert

  • Member
  • Posts: 2,658
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #11 on: July 27, 2006, 11:02:28 am »
Gary:

"  ... the fact that your doctor is more concerned about the possibility of juandice associated with Reyataz (which, by the way, is believed to be purely cosmetic; it does not indicate underlying damage to the liver)."

I'm on the Reyataz/Norvir combination and the juandice was temporary.  A yellowing of the skin and eyes for a few weeks and that was it.  NEver any damange to the liver.

robert
..........

Offline Lou-ah-vull

  • Member
  • Posts: 1,029
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #12 on: July 27, 2006, 11:23:03 am »
I can't thank you all enough for the advice and information.  It is causing me to wonder about my doctor.  He was recommended to me by my internist when I learned I was positive in October.  I know that he treats other HIV patients and seems well informed.  He is easy to reach, returns calls promptly, always takes time to talk when I meet with him.  This is the first time I have had reason to question him.  What I need to do is call and make an appointment and discuss my concerns.  I think I have enough information to have an intelligent discussion with him now.  As I see it, I am taking on a known risk of resistance (and I am not yet undetectable, although I am close) and going off label for a regimen that has been documented to fail in the past.  I need to know why his judgment is to go off label with Invirase (with these incumbent risks) and wait six weeks for testing to see if there is a good lipid response. 

I have posted this same question on The Body website and am waiting for the doctor to answer.  I am going to do the same on the Hopkins website, but for some reason this morning, their forum won't load in my browser.  I will also pay for a second opinion from a doctor in town if my doctor continues to recommend using the unboosted Invirase.  I will let everyone know here what I learn because I know it will benefit others.

At this point, I don't want to think about changing doctors, I really like this doctor and he is convenient, but I sure need to understand why he is suggesting I do something that conventional wisdom suggests otherwise.

Thank you so much for the information and advice.  This is manageable for me, but nevertheless overwhelming and scary.  I am still in first year of adjusting to the shock of all of this!  God knows what I would do without this website.  I am so looking forward to Montreal!

Gary   :D
Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
05/06:  Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), UD
02/07:  Switched to Atripla 2/8/07
04/07:  566 (37.7%), UD
08/07:  761 (42.3%), UD
06/08:  659 (47.1%), UD
01/09:  613 (43.8%), UD
07/09:  616 (47.4%), UD
01/10:  530 (44.2%), UD
07/10:  636 (48.9%), UD
01/11:  627 (48.2%), UD
07/11:  840 (52.5%), UD
01/12:  920 (51.1%), UD
07/12:  857 (50.4%), 40
10/12:  UD
01/13:  710 (47.3%), UD
07/13:  886 (49.2%), UD
01/14:  985 (46.9%), UD
06/14:  823 (47.2%), UD
01/15: 1366 (45.2%), UD
07/15: 1134 (50.7%), UD
02/16: 1043 (55.1%), UD
08/16:  746  (55.4%), UD
08/16:  Switch from Atripla to Genvoya

Offline Lou-ah-vull

  • Member
  • Posts: 1,029
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #13 on: July 27, 2006, 05:51:19 pm »
This is what Dr. Gallant had to say about this at the Hopkins website:

You SHOULD be alarmed. We've known since the late 1990's that drug levels are completely inadequate with unboosted Invirase. That's why it was replace by Fortovase, and only began to be used again when we started boosting PIs with ritonavir. We haven't been using unboosted Invirase since it was virtually the only choice back in 1996. If you want to replace Kaletra with a PI that doesn't increase lipids as much, then you could consider BOOSTED Invirase or Reyataz. But I should point out that your lipids aren't all that bad. Triglycerides of 480 are elevated but not dangerous, and an LDL of 91 is great by anyone's standards. To jeopardize your virologic control based on these results would be crazy.

I rarely say this sort of thing so directly, but if your doctor is recommending unboosted Invirase, which is a "not recommended" agent according to current guidelines, then he doesn't know his stuff and you need to find someone else.

Gerry...thanks for steering me to the Hopkins website.  The question was answered within a few hours.  Also, I have submitted the question on TheBody website, but there turnaround time is a bit longer.  I will post their answer here when I get it.

This has really thrown me for a loop.  I am going to make an appointment with my doctor and share all of this with him.  Since I am the one taking the risk of resistance, he is going to have to give me different options than what he has recommended.  Perhaps I will learn more in a conversation with him as to why he was recommending this.  Thank you all for helping me.

Gary
Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
05/06:  Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), UD
02/07:  Switched to Atripla 2/8/07
04/07:  566 (37.7%), UD
08/07:  761 (42.3%), UD
06/08:  659 (47.1%), UD
01/09:  613 (43.8%), UD
07/09:  616 (47.4%), UD
01/10:  530 (44.2%), UD
07/10:  636 (48.9%), UD
01/11:  627 (48.2%), UD
07/11:  840 (52.5%), UD
01/12:  920 (51.1%), UD
07/12:  857 (50.4%), 40
10/12:  UD
01/13:  710 (47.3%), UD
07/13:  886 (49.2%), UD
01/14:  985 (46.9%), UD
06/14:  823 (47.2%), UD
01/15: 1366 (45.2%), UD
07/15: 1134 (50.7%), UD
02/16: 1043 (55.1%), UD
08/16:  746  (55.4%), UD
08/16:  Switch from Atripla to Genvoya

Offline whizzer

  • Member
  • Posts: 392
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #14 on: July 27, 2006, 06:13:10 pm »
Gary,

When one doctor tells you that your doctor doesn't know his stuff, then you should find yourself a new doctor.  Doctors never say that sort of thing about a colleague unless they REALLY think the guy is incompetent.  I would set about finding a new ID  doctor right away, even though it may not be as convenient as the one you are now seeing.  Share what you've learned with your current doctor, but only as part of a fond farewell.  I would also tell your GP about your dissatisfaction, so he can decide whether he wants to continue to send referrals to this guy.

By the way, studies show a direct correlation between the expertise in HIV of  physicians and the life span of HIV infected patients.

Good luck with it.

-Edited to correct my dyslexic word order.

-Whiz
« Last Edit: July 27, 2006, 06:17:15 pm by whizzer »

Offline SouthSam7

  • Member
  • Posts: 428
Re: Need Advice on Switching from Kaletra to Invirase
« Reply #15 on: July 27, 2006, 11:18:15 pm »
I was diagnosed in nov of 05, and because of my numbers was immediately put on my current combo, Truvada, Invirase and Norvir.  I had the usual side effects, but the only one that I still have is a big belly. 

I am somewhat new to this and am always looking at new treatments, but there is NO WAY I would change what I'm doing now unless I get resistant to something I'm taking.  Norvir and Invirase apparently aren't the most common or new PI's, but I have NO side effects now except for the big belly.  I strongly approve of Invirase and Norvir. 

p.s. I would like to thank all of you.  98% of what I've learned about this disease I learned from these forums!  My ASO is no help at all.  I love you all!  Thanks!  Sam in 'bama

 


Terms of Membership for these forums
 

© 2024 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.