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Few options High Lipids

Posted: Jun 30, 2007

QUESTION:

This is a re send Incomplete info with previous question I have a patient who is treatment experienced d4t ddI NVP NFV 3TC until 2003 2000 and 2003 GARTS detected D67NS F77L Q151M M184V T181C D30N N88D L10IRV K20Dr M36I L63p 2003 Phenotype = Only TDF active He became non detectable on LPVrtv 3 BID APV 1200 BID TDF and 3TC. When Agenerase was discontinued I switched to Fos APV and he remained non detectable for 3 years Fos APV stopped 6 months ago and he remains non detectable on LPV 600 BID RTV 150 BID TDF 300/D and Emtriva 200 per day. Triglycerides remain at 900 in spite of intensive statin and Lopid therapy. I am considering replacing the Kaletra with either boosted ATV or Darunavir. What do you think?


  

RESPONSE FROM:   

    I assume this man has been told to reduce simple sugars as a first and necessary step to reducing his triglycerides. Given that, I think you have three options:

    1. You could switch from LPV/RTV to atazanavir/ritonavir. There are data to suggest this switch will lead to a reduction in trigloycerides. There are no such data with darunavir. There could be a bit of an increased risk of virologic breakthrough with boosted atazanavir so I would watch the viral load closely - checking it 2 weeks after the switch and again 2 weeks after that. IF virus pops up you could go back to LPV/RTV or try darunavir/RTV.

    2. You could drop the dose of LPV/RTV to the standard 400/100 twice a day (2 tablets twice a day). This should be fine and may well reduce his triglycerides. I favor this option.

    3. Add fish oil to the fenofibrate. A dose of 4 to 6 grams a day of combined DHA and EPA (the active ingredients of fish oil) should reduce triglycerides but probably not to below 400.

    Please let us know what you do and how it works.

    DW




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