Question
Treatment choices to reduce high cholesterol…
20 August 2009. Related: All topics, Changing treatment, Side effects.
I have been on Kaletra (2 twice per day) and Truvada (1 per day) for two years and my results have been very good. V/L undetectable, CD4s 1100 +.
My doctor is worried about my cholesterol levels and thought the Kaletra was driving this. We changed about three months ago to Atripla but after six weeks my life became very unpleasant with drug side effects so we reverted back to the Kaletra regimen.
The latest thought is that we change to raltegravir (Isentress) but I am not sure what combination to take with this.
Could you advise the considered best combination regimen that will not have drug interactions. I can then check this out when we make the change in October.
Previous answers from you have been very helpful for which I thank you and look forward to yor next reply.
Many thanks
Answer
Hi
Although we don’t recommend one treatment over another, we can perhaps help with information that will help when you next speak to your doctor.
The two main HIV drugs that you could switch to are either raltegravir (Isentress), which does not increase any blood lipids, or to atazanavir/ritonavir 300/100mg (Reyataz/Norvir), which is likely to increase cholesterol less than Kaletra. Also, some people using atazanavir/ritonavir, after viral load has been undetectable for six months or so, may be able to drop the ritonavir and use a 400mg dose of atazanavir which would also not increase cholesterol at all.
In the UK, access to raltegravir (Isentress) is currently limited to people with drug resistance, because the price is higher than other alternatives. In other countries there may not be such a difference in price compared to atazanavir (Reyataz), so this issue will depend on where you are living.
Raltegravir has produced very good results, but is a twice-daily drug, whereas atazanavir is generally taken once-daily.
Without knowing which drug interaction you are worried about it is difficult to comment on this part of your question. Hopefully, if you use a combination that doesn’t increase cholesterol, you might not need a lipid-lowering drug to reduce it.
Either option can still be used with Truvada (tenofovir + FTC) as you will not have developed resistance, if your viral load is still undetectable.
Information on all ARVs is available on this page.
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