Slide 64 of 76
Notes:
- MC likely is experiencing viral breakthrough because of subtherapeutic nelfinavir levels secondary to an interaction with her anticonvulsant
- carbamazepine is a potent CYP3A inducer, likely decreased nelfinavir
- emergence of D30N mutation supports likelihood of viral replication in presence of low nelfinavir concentrations
- MC’s physician would like to change her regimen to one containing a boosted PI combination. This regimen has many advantages, including:
- greatly increased indinavir concentrations secondary to ritonavir inhibition
- potent antiviral activity
- b.I.d. dosing, fewer pills to take
- no empty stomach requirements
- lower dose of ritonavir better tolerated
