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Three patients present for regular outpatient care. As described below, all have stable HIV disease, with undetectable viral loads and normal or near-normal CD4-cell counts. None has experienced virologic failure on any treatment or has a known history of drug resistance. All are without adverse effects on their current regimens.
This week, we ask for your opinion. Next week, we will present the opinions of three experts.
Patient 1 is a 50-year-old man who has been taking abacavir, 3TC, and efavirenz since 2001. He has no renal disease but does have hyperlipidemia (well controlled with atorvastatin). His father died of a myocardial infarction at age 48.
Patient 2 is a 63-year-old man who has been taking efavirenz and lopinavir/ritonavir since 2002. While on an earlier regimen — d4T, 3TC, and indinavir — he developed a severe neuropathy, which left him with residual numbness and tingling in his feet. He now needs to go on an inhaled corticosteroid to treat increasingly refractory asthma.
Patient 3 is a 35-year-old woman who has been taking abacavir, 3TC, and twice-daily ritonavir-boosted fosamprenavir since starting this regimen in a clinical trial 5 years ago. Each week, she misses about two afternoon doses of the boosted fosamprenavir.
For each patient, would you switch or alter the current regimen? If yes, to what — and why? Submit your comments below.
Note: The expert opinions have now been published.