In early May, the FDA approved once-daily dosing of Abbott’s powerhouse
protease inhibitor (PI) Kaletra (lopinavir plus booster ritonavir)—but
only for folks new to HIV meds. For now, the rest of you are stuck with
the twice-a-day: Once-daily hasn’t been tested in old-timers, and some
HIV docs and treatment advocates worry that the PI’s blood levels will
fall too low over 24 hours to work in folks with resistant virus. And
once-daily dosing comes with a caution as big and bold as Kaletra’s
famously bright-orange capsule: The incidence of diarrhea may rise if
you take Kaletra all at once rather than in two daily doses. Still, one
dose is one less to worry about. And Abbott is reformulating the
soft-gel capsule into a tablet, hoping that the new tab will table
Kaletra’s gastro side effects. The tablet will reduce the daily pill
total from six to four and may avoid the PI’s take-with-food
restriction (it’s being tested with and without). What’s more, it will
omit one ingredient—fatty oleic acid—which Abbott’s George Hanna, MD, fingers
for the diarrhea and nausea. The new tabs are being tested in HIVers
new and old to meds. Last but not least, Abbott foresees a Norvir
(ritonavir) remix, so HIVers who use Norvir to boost other PIs may be
able to kick those icky side effects, too.
