Boosted vs non-boosted Reyataz

[Guest guest]

I've been undetectable for 2 1/2 years on boosted Reyataz plus

Epzicon (abacavir plus epivir). Conventional wisdom is that " boosted

is better " . But I've read in this site and other sites that " boosted

is exaggerated " .

I'm just wondering what are the risks and benefits of

switching to unboosted Reyataz. Certainly not needing to refrigerate

the Norvir and simplifying the regimen and less lipids is an advantage

to non-boosting. But is it losing the advantage of the Reyataz being

more level a significant risk to giving up the boosting?

[Guest guest]

I maintained an undetectable viral load for three years using 400 mg Reyataz once a day (the standard dose for my height and weight). But I am convinced a higher Trough Dose of Reyataz is indeed desirable.

Normally, my T4 count and percentage declines by a slow predictable amount each month after using Interleukin-2. By increasing my dose of Reyataz from 400 mg once a day to 300 mg twice a day, this slow decay in T4 count and percentage has been reduced by 90% or so. So there are benefits from a higher dose of Reyataz.

In an attempt to minimize some of the reported side-effects of protease inhibitors on the cardiovascular system, I have been using 500 mg of bioflavinoids sourced from lemons. Of the published studies testing substances whih counter these effects this seems among the most promising, and for me the substance without side-effects. There are no human trials showng this is effective, but it has been long available over the counter. If you try this, be certain your bioflavinoids are not sourced from grapefruit as grapefruit bioflavinoids will act like Norvir and increase the levels of many drugs including protease inhibitors.

I have my results back from a variety of methods of using Reyataz. The published literature documents that protease inhibitors, including Norvir, above a certain level actually induce more CYP liver enzyme activity - and thus actually results in lower protease inhibitor drug levels. You can see this effect in my Trough Reyataz levels being lower for 400 mg BID compared with 300 mg BID. Re-testing shows nearly identical results.

For me, 300 mg Reyataz twice day produces superior drug Trough Levels, especially when compared with side-effects in a therapeutic index using Direct Bilirubin levels as a surrogate for all side-effects.

One of the most notable results is that my Reyataz trough levels are significantly below published results in all scenarios, highlighting the importance of testing your own Trough levels with Gas Chromatography. My body destroys Reyataz far more quickly than is typical. Human variation in this regard is quite significant, as can be seen in the difference between the published minimum and maximum drug trough levels.

Percent of

Percent of

Index

(30 to 410) Reyataz Trough ug/L

IC-90

Direct

Normal Max

Bilirubin /

75

Bilirubin

0.20

Trough

400 mg once daily & 50 mg Norvir

480

533%

0.60

300%

1.3

400 mg once daily

160

178%

0.15

75%

0.9

800 mg once daily

300

333%

0.50

250%

1.7

300 mg twice daily

1,100

1,222%

0.50

250%

0.5

400 mg twice daily

880

978%

0.90

450%

1.0

(lowest)

646

718%

published - 300 mg & 100 mg Norvir

774

860%

(highest)

902

1,002%

(lowest)

94

104%

published - 400 mg once daily

282

313%

(highest)

468

520%

Note: IC-90 is the drug level which inhibits 90% of viral activity.

So for me, 300 mg twice a day results in a Reyataz level, just before I take the next dose, which is 12.22 times higher than the IC-90 level. My 400 mg dose once a day Trough level was just 1.78 times IC-90; and my Trough level boosted with 50 mg Norvir was 5.33 times IC-90.

Moving my Trough Reyataz drug level from 5.33x IC-90 to 12.22x IC-90 has significantly reduced the rate of decline in my T4 count and percent between interleukin-2 injections. So I'm sold on this idea.

For comparison the published average Trough level for 300 mg Reyataz boosted with 100 mg Norvir is 8.6 times higher than the IC-90 level and 3.3 times IC-90 without Norvir.

>> I've been undetectable for 2 1/2 years on boosted Reyataz plus> Epzicon (abacavir plus epivir). Conventional wisdom is that "boosted> is better". But I've read in this site and other sites that "boosted> is exaggerated". > I'm just wondering what are the risks and benefits of> switching to unboosted Reyataz. Certainly not needing to refrigerate> the Norvir and simplifying the regimen and less lipids is an advantage> to non-boosting. But is it losing the advantage of the Reyataz being> more level a significant risk to giving up the boosting?>

[Guest guest]

"I've been undetectable for 2 1/2 years on boosted Reyataz plusEpzicon (abacavir plus epivir). Conventional wisdom is that "boostedis better". But I've read in this site and other sites that "boostedis exaggerated". I'm just wondering what are the risks and benefits ofswitching to unboosted Reyataz. Certainly not needing to refrigeratethe Norvir and simplifying the regimen and less lipids is an advantageto non-boosting. But is it losing the advantage of the Reyataz beingmore level a significant risk to giving up the boosting?"Boosting has very profound effects on the pharmacology of many protease inhibitors, which is why Abbott can behave like a common criminal with pricing the drug.  .  Boosting decreases the risk of viral drug resistance, and gives you a bit more flexibility with timing of your drug doses.  While some very emotional discussion has happened here against Norvir boosting, these opinions are not justified by any publications or knowledge of even basic pharmacology.The downside of boosting is Novir's effects on blood lipids (triglycerides and cholesterol) which can be profound.  Personally, I find Norvir's refrigeration requirements to be no big deal.   It doesn't need to be refrigerated constantly, and unless you're planning to do a Sahara camping trip, I don't think it's that much of a problem.If you have been an "experienced" patient, and this is not your first drug cocktail, then boosting Reyataz is standard practice, and I would strongly recommend against discontinuing Norvir.If this is your first drug combination, using unboosted Reyataz is something you should discuss this with your doctor.   Barrowpozbod@...

[Guest guest]

I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo).

I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split.

my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it.

i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day.

So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.)

BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc.

cheers edward

[Guest guest]

I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo).

I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split.

my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it.

i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day.

So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.)

BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc.

cheers edward

[Guest guest]

It's good to hear that unboosted Reyataz has worked so well. It is also good information that you have been advised to take 400mg at once instead of splitting it, though many folks say that splitting is OK. I would guess that the Norvir you hated in 1997 is the infamous liquid. The one Norvir pill I take to boost is not bad at all. Actually, it was my doctor's suggestion to consider unboosted because of lipids, and I've been the conservative one cautious about risking my 2.4 year undectable streak since it's only 100mg Norvir, but still. Congrats on being undectable 10 years after!EddieKsf@... wrote: I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo). I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split. my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it. i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day. So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age

63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.) BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc. cheers edward

CHECK OUT MY WEBSITE AT WWW.XANGA.COM/KEVIN72 . THANKS!!!!!

Friday, January 21, 2005

IRAQIC (adjective)--- a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts millions of people.

IRANIC (adjective)---a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts hundreds of millions of people (coming August 2005).

No draft!!! No incursions!!! Bush don't attack the Persians!!!

[Guest guest]

It's good to hear that unboosted Reyataz has worked so well. It is also good information that you have been advised to take 400mg at once instead of splitting it, though many folks say that splitting is OK. I would guess that the Norvir you hated in 1997 is the infamous liquid. The one Norvir pill I take to boost is not bad at all. Actually, it was my doctor's suggestion to consider unboosted because of lipids, and I've been the conservative one cautious about risking my 2.4 year undectable streak since it's only 100mg Norvir, but still. Congrats on being undectable 10 years after!EddieKsf@... wrote: I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo). I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split. my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it. i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day. So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age

63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.) BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc. cheers edward

CHECK OUT MY WEBSITE AT WWW.XANGA.COM/KEVIN72 . THANKS!!!!!

Friday, January 21, 2005

IRAQIC (adjective)--- a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts millions of people.

IRANIC (adjective)---a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts hundreds of millions of people (coming August 2005).

No draft!!! No incursions!!! Bush don't attack the Persians!!!

[Guest guest]

Like you, I can maintain an undetectable viral load with 400 mg Reyataz, with or without Viread and Emtriva.

Prior to enrolling in the Crixivan trial, I used ddI, ddC, and briefly d4T in an attempt to control HIV in combination with Interferon-alpha. Since I had access to a viral load lab since December 1993 I can tell you that, even during initial use, and in combination, these drugs were not very effective at controlling HIV. Its interesting to note that while combination therapy is almost always more effective, my Doctor at the time received a lot of criticism for prescribing combination therapy at a time when virtually no Doctor used this approach.

The weak showing of these early drugs has arguably led to over-combination of more powerful later drugs. The idea that every antiviral regimen needs to include at least one drug from every available class is one example of this. Fortunately this simplistic approach is being replaced with reality based regimens based on study results.

Prior to the Crixivan trial, the only way I could maintain an undetectable viral load was with a very aggressive regimen of Interleukin-2 every three weeks - whose side effects were remarkably more obnoxious than the every other month regimen I used later. I was very excited to be using Crixivan. Although I sent my study drug out to a Reference Lab for identification, I really didn't need the answer once I saw my undetectable viral load without the aid of Interleukin-2.

I used Crixivan with 3TC during the first year and then with Viramune for another seven years. I changed to Reyataz when it was available to eliminate my increasing lipid problems from Crixivan which developed during my seventh and eight year of Crixivan usage.

You and I have not experienced any problems in controlling our viral load with protease inhibitors, but not everyone has had this same experience.

There are those who have failed one drug regimen after another and live in fear that their current regimen will fail at any time in spite of taking regimens which appear to us to be grotesquely over-medicated. Yet their personal experience has demonstrated that these extreme regimens are necessary.

Generalizing our approach to them, or their approach to us, is obviously foolish - yet it is easy to understand how seductive it can be to make sweeping comments about "the right approach" that should apply to everyone.

It should be obvious that the treatment strategy needs to be tailored to each person, as most intelligent Doctors do. Some regimented clinics insist on a one approach fits all, and it is usually the poor and uneducated who are the recipients of this assembly-line approach to medicine.

/message/20049

just posted this study "Incidence of Metabolic Syndrome in HIV Positive Adults" which found that "The incidence of metabolic syndrome was associated with having less than college education". Are less educated people more likely to receive assembly-line medical care featuring the least expensive treatments, and more likely to blindly follow their prescribed regimen regardless of the results? I don't know, but I suspect there are a number of untold stories in that finding.

I noticed that I have been able to skip my Interleukin-2 therapy and still maintain my T4 count around 1,300 and 40% by doubling my minimum level of Reyataz from 480 micrograms per liter to 1,100 micrograms per liter (ug/L). I achieved this by dropping my 400 mg Reyataz with 50 mg Norvir and replacing it with 300 mg Reyataz twice a day without Norvir.

/message/20061

My trough Reyataz level using only 400 mg once a day without Norvir was 160 ug/L. While adding 50 mg Norvir to the regimen tripled my trough Reyataz level to 480 ug/L, I did not experience any measurable benefits from this, such as an increased T4 count or a slower decline in T4 percentage after using Interleukin-2. Yet a further doubling of my Reyataz trough level to 1,100 ug/L did provide these benefits. It was most interesting to see that 300 mg Reyataz twice a day provided me with a higher trough level than 400 mg Reyataz twice a day.

So once again, I am a big proponent of individualizing your treatment to your own response and history.

For reference, the highest single dose of Reyataz which has been used was roughly 12,000 mg. A person attempted to kill themselves with by taking all of their Reyataz all at once - more than a 30 day supply. Taken to the emergency room, the only abnormality which was observed was a minor EKG irregularity for a few hours. This person experienced no other side-effects, not even indigestion.

>> I have always believed in the theory that with big pharma's meds, LESS is > always better (especially with my lipo). > I started Reyataz in jan 05, switching after many years of sustiva, > finally got tired of the dreams. I'm on two 200's once a day as my doc said > important for drug level not to split. > my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did > norvir in about '97 and hated it. > i even dropped from one 400 didanosine (generic videx) a day to 250mg > didanosine per day. > So how's it workin?? My t's are in the 600 range, and i've had > undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a > horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm > still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the > test, but as i said, that was the last time i wasn't monogamous before the > test.) > BUT, that's only MY experience. Fortunately for me, i think my genetic > makeup is strong against hiv. You could try it and keep close watch, but the > INSTANT the t's drop or vl starts to climb, go right back to boosted before > the resistance sets in. This is important, and i can't refute the info from > and Norm. As says, talk to ur doc. > > cheers> edward>

[Guest guest]

Like you, I can maintain an undetectable viral load with 400 mg Reyataz, with or without Viread and Emtriva.

Prior to enrolling in the Crixivan trial, I used ddI, ddC, and briefly d4T in an attempt to control HIV in combination with Interferon-alpha. Since I had access to a viral load lab since December 1993 I can tell you that, even during initial use, and in combination, these drugs were not very effective at controlling HIV. Its interesting to note that while combination therapy is almost always more effective, my Doctor at the time received a lot of criticism for prescribing combination therapy at a time when virtually no Doctor used this approach.

The weak showing of these early drugs has arguably led to over-combination of more powerful later drugs. The idea that every antiviral regimen needs to include at least one drug from every available class is one example of this. Fortunately this simplistic approach is being replaced with reality based regimens based on study results.

Prior to the Crixivan trial, the only way I could maintain an undetectable viral load was with a very aggressive regimen of Interleukin-2 every three weeks - whose side effects were remarkably more obnoxious than the every other month regimen I used later. I was very excited to be using Crixivan. Although I sent my study drug out to a Reference Lab for identification, I really didn't need the answer once I saw my undetectable viral load without the aid of Interleukin-2.

I used Crixivan with 3TC during the first year and then with Viramune for another seven years. I changed to Reyataz when it was available to eliminate my increasing lipid problems from Crixivan which developed during my seventh and eight year of Crixivan usage.

You and I have not experienced any problems in controlling our viral load with protease inhibitors, but not everyone has had this same experience.

There are those who have failed one drug regimen after another and live in fear that their current regimen will fail at any time in spite of taking regimens which appear to us to be grotesquely over-medicated. Yet their personal experience has demonstrated that these extreme regimens are necessary.

Generalizing our approach to them, or their approach to us, is obviously foolish - yet it is easy to understand how seductive it can be to make sweeping comments about "the right approach" that should apply to everyone.

It should be obvious that the treatment strategy needs to be tailored to each person, as most intelligent Doctors do. Some regimented clinics insist on a one approach fits all, and it is usually the poor and uneducated who are the recipients of this assembly-line approach to medicine.

/message/20049

just posted this study "Incidence of Metabolic Syndrome in HIV Positive Adults" which found that "The incidence of metabolic syndrome was associated with having less than college education". Are less educated people more likely to receive assembly-line medical care featuring the least expensive treatments, and more likely to blindly follow their prescribed regimen regardless of the results? I don't know, but I suspect there are a number of untold stories in that finding.

I noticed that I have been able to skip my Interleukin-2 therapy and still maintain my T4 count around 1,300 and 40% by doubling my minimum level of Reyataz from 480 micrograms per liter to 1,100 micrograms per liter (ug/L). I achieved this by dropping my 400 mg Reyataz with 50 mg Norvir and replacing it with 300 mg Reyataz twice a day without Norvir.

/message/20061

My trough Reyataz level using only 400 mg once a day without Norvir was 160 ug/L. While adding 50 mg Norvir to the regimen tripled my trough Reyataz level to 480 ug/L, I did not experience any measurable benefits from this, such as an increased T4 count or a slower decline in T4 percentage after using Interleukin-2. Yet a further doubling of my Reyataz trough level to 1,100 ug/L did provide these benefits. It was most interesting to see that 300 mg Reyataz twice a day provided me with a higher trough level than 400 mg Reyataz twice a day.

So once again, I am a big proponent of individualizing your treatment to your own response and history.

For reference, the highest single dose of Reyataz which has been used was roughly 12,000 mg. A person attempted to kill themselves with by taking all of their Reyataz all at once - more than a 30 day supply. Taken to the emergency room, the only abnormality which was observed was a minor EKG irregularity for a few hours. This person experienced no other side-effects, not even indigestion.

>> I have always believed in the theory that with big pharma's meds, LESS is > always better (especially with my lipo). > I started Reyataz in jan 05, switching after many years of sustiva, > finally got tired of the dreams. I'm on two 200's once a day as my doc said > important for drug level not to split. > my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did > norvir in about '97 and hated it. > i even dropped from one 400 didanosine (generic videx) a day to 250mg > didanosine per day. > So how's it workin?? My t's are in the 600 range, and i've had > undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a > horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm > still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the > test, but as i said, that was the last time i wasn't monogamous before the > test.) > BUT, that's only MY experience. Fortunately for me, i think my genetic > makeup is strong against hiv. You could try it and keep close watch, but the > INSTANT the t's drop or vl starts to climb, go right back to boosted before > the resistance sets in. This is important, and i can't refute the info from > and Norm. As says, talk to ur doc. > > cheers> edward>

[Guest guest]

I am uncertain of the results of splitting a 400 mg Reyataz dose into two 200 mg doses. I have not tried it myself and there are no published results. It may result in a higher drug trough level than 400 mg once a day, but there is a possibility that the trough level could be lower.

There are two possible competing forces at work. On one hand two doses will normally result in a higher ending trough level in the blood plasma just prior to the next dose. My trough levels are 160 ug/L for 400 mg Reyataz, 480 ug/L for 400 mg Reyataz boosted with Norvir, and 1,100 ug/L for 300 mg Reyataz twice a day.

So it might seem reasonable to assume that 200 mg Reyataz twice a day would result in a trough level higher than 160 ug/L and lower than 1,100 ug/L - since 200 mg twice a day is only 1/3 less than 300 mg twice a day.

But the confounding factor is that below a certain dose, too little of the drug dose survives the first-pass of enzyme destruction in the intestine and liver. These given level of enzymes in each person's system at any given time can quickly destroy a fixed amount drug. Lets make up a number and say this is 150 mg of Reyataz. In this example the initial starting dose with 300 mg is 150 mg (300 - 150) compared with a 50 mg dose (200 - 150) when using a 200 mg dose.

My Doctor has one patient who does not tolerate Norvir well and insists upon a twice daily dosing regimen of when he wakes up 8 am and when he goes to bed 12 midnight. This results in one eight hour period and one 16 hour period. In this case, my Doctor prescribes 400 mg Reyataz for the morning dose an 200 mg Reyataz for the evening dose. This results in a trough Reyataz level which is superior to Norvir boosted Reyataz at both 8 am and midnight.

Individualizing therapy in this way may be beyond the competence and experience level of some Doctors. But you can see that many suitable dosing arrangements can be designed.

The results always need to be confirmed with drug Trough level testing by gas chromatography on a blood sample. The reason is there is a large genetic variance in how drugs are metabolized. As an example the published minimum, average, and maximum for Reyataz for large groups displays a huge four-fold variance.

person with lowest trough level

94 ug/L

average 400 mg once daily

282 ug/L

person with highest trough level

468 ug/L

Generally, the higher your Trough Reyataz level is above 75 ug/L the more effective the viral inhibition wil be.

75 ug/L is the level which inhibits 90% of viral activity.

This is more than five times the Reyataz trough level, 14 ug/L, which is needed to inhibit only 50% of viral activity.

The closer you wish to come to 100% viral inhibition, a level you can never achieve, the higher the drug trough level needs to be.

This is people with a higher level of immune function, such as those who begin antiviral therapy while their immune system is still larely intact, experience fewer problems with drug resistance. The immune system needs to control the viral activity the drugs do not.

This manifests itself in me as a trade-off between drug trough level and the frequency of interleukin-2 treatments needed to maintain a normal T4 count and percentage. Raising my Reyataz trough level from 480 ug/L to 1,100 ug/L has so far allowed me to skip two interleukin-2 treatments and maintain comparable results.

I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo). > I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split. > my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it. > i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day. > So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.) > BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc. > cheers> edward> > > > > CHECK OUT MY WEBSITE AT WWW.XANGA.COM/KEVIN72 . THANKS!!!!!> Friday, January 21, 2005> > > > IRAQIC (adjective)--- a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts millions of people.> > IRANIC (adjective)---a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts hundreds of millions of people (coming August 2005).> > No draft!!! No incursions!!! Bush don't attack the Persians!!!>

[Guest guest]

I am uncertain of the results of splitting a 400 mg Reyataz dose into two 200 mg doses. I have not tried it myself and there are no published results. It may result in a higher drug trough level than 400 mg once a day, but there is a possibility that the trough level could be lower.

There are two possible competing forces at work. On one hand two doses will normally result in a higher ending trough level in the blood plasma just prior to the next dose. My trough levels are 160 ug/L for 400 mg Reyataz, 480 ug/L for 400 mg Reyataz boosted with Norvir, and 1,100 ug/L for 300 mg Reyataz twice a day.

So it might seem reasonable to assume that 200 mg Reyataz twice a day would result in a trough level higher than 160 ug/L and lower than 1,100 ug/L - since 200 mg twice a day is only 1/3 less than 300 mg twice a day.

But the confounding factor is that below a certain dose, too little of the drug dose survives the first-pass of enzyme destruction in the intestine and liver. These given level of enzymes in each person's system at any given time can quickly destroy a fixed amount drug. Lets make up a number and say this is 150 mg of Reyataz. In this example the initial starting dose with 300 mg is 150 mg (300 - 150) compared with a 50 mg dose (200 - 150) when using a 200 mg dose.

My Doctor has one patient who does not tolerate Norvir well and insists upon a twice daily dosing regimen of when he wakes up 8 am and when he goes to bed 12 midnight. This results in one eight hour period and one 16 hour period. In this case, my Doctor prescribes 400 mg Reyataz for the morning dose an 200 mg Reyataz for the evening dose. This results in a trough Reyataz level which is superior to Norvir boosted Reyataz at both 8 am and midnight.

Individualizing therapy in this way may be beyond the competence and experience level of some Doctors. But you can see that many suitable dosing arrangements can be designed.

The results always need to be confirmed with drug Trough level testing by gas chromatography on a blood sample. The reason is there is a large genetic variance in how drugs are metabolized. As an example the published minimum, average, and maximum for Reyataz for large groups displays a huge four-fold variance.

person with lowest trough level

94 ug/L

average 400 mg once daily

282 ug/L

person with highest trough level

468 ug/L

Generally, the higher your Trough Reyataz level is above 75 ug/L the more effective the viral inhibition wil be.

75 ug/L is the level which inhibits 90% of viral activity.

This is more than five times the Reyataz trough level, 14 ug/L, which is needed to inhibit only 50% of viral activity.

The closer you wish to come to 100% viral inhibition, a level you can never achieve, the higher the drug trough level needs to be.

This is people with a higher level of immune function, such as those who begin antiviral therapy while their immune system is still larely intact, experience fewer problems with drug resistance. The immune system needs to control the viral activity the drugs do not.

This manifests itself in me as a trade-off between drug trough level and the frequency of interleukin-2 treatments needed to maintain a normal T4 count and percentage. Raising my Reyataz trough level from 480 ug/L to 1,100 ug/L has so far allowed me to skip two interleukin-2 treatments and maintain comparable results.

I have always believed in the theory that with big pharma's meds, LESS is always better (especially with my lipo). > I started Reyataz in jan 05, switching after many years of sustiva, finally got tired of the dreams. I'm on two 200's once a day as my doc said important for drug level not to split. > my doc (reluctantly) and i agreed to do the unboosted, mainly cuz i did norvir in about '97 and hated it. > i even dropped from one 400 didanosine (generic videx) a day to 250mg didanosine per day. > So how's it workin?? My t's are in the 600 range, and i've had undetectable vl since 1997 (except one blip to 400. However, i'm also healthy as a horse, age 63, retired 10 yrs ago on disability (the gov't is wonderin why i'm still here), and goin on 24 yrs poz (yea, donovan, i know that's befo the test, but as i said, that was the last time i wasn't monogamous before the test.) > BUT, that's only MY experience. Fortunately for me, i think my genetic makeup is strong against hiv. You could try it and keep close watch, but the INSTANT the t's drop or vl starts to climb, go right back to boosted before the resistance sets in. This is important, and i can't refute the info from and Norm. As says, talk to ur doc. > cheers> edward> > > > > CHECK OUT MY WEBSITE AT WWW.XANGA.COM/KEVIN72 . THANKS!!!!!> Friday, January 21, 2005> > > > IRAQIC (adjective)--- a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts millions of people.> > IRANIC (adjective)---a form of ironic where you cause to happen what you were trying to avoid on a scale that negatively impacts hundreds of millions of people (coming August 2005).> > No draft!!! No incursions!!! Bush don't attack the Persians!!!>

[Guest guest]

Reyataz is not approved without boosting for treatment-experienced patients.This is because of the risk of viral resistance, and the concerns of those who actually treat patients, and do pharmacology studies, rather than on the experience of one individual patient, who may either be doing an excellent job on his own, or simply being very lucky.That's the problem with n=1 studies.  You can't rule out a good result vs dumb luck. Barrowpozbod@...

[Guest guest]

Reyataz is not approved without boosting for treatment-experienced patients.This is because of the risk of viral resistance, and the concerns of those who actually treat patients, and do pharmacology studies, rather than on the experience of one individual patient, who may either be doing an excellent job on his own, or simply being very lucky.That's the problem with n=1 studies.  You can't rule out a good result vs dumb luck. Barrowpozbod@...