Case #1 - Ms. MC

• MC is a 28 year old female, newly Dx with HIV+

  • antiretroviral naïve, CD 408, VL 50,000 copies/mL
  • also has preexisting seizure Hx (Rx carbamezepine)

• Started on AZT, 3TC, nelfinavir

  • good initial response, but then viral load ? (interaction with anticonvulsant?)
  • genotype shows presence of D30N mutation

• Wishes to switch to boosted regimen:

  • d4T, ddI, indinavir 800 mg/ritonavir 100 mg BID

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• 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