Balancing treatments for both your tummy and HIV can seem like a pain sometimes, but it is doable
You and your doc should be able to find a combo that does the job for
both HIV and your tummy. This may mean changing your stomach
medication, changing your HIV meds or altering dosing schedules so the
two types of meds don’t interact.
Though Norvir (a PI) is the
undisputed king of drug interactions among HIV meds, it actually works
just fine with most gastric modifiers. Instead, it’s another PI that
throws a royal fit when mixed with most GERD drugs.
Dr. Young
says, “I have been concerned [about the] reduction in drug exposure of
Reyataz when co-administered with some gastric modifiers such as H2
blockers.”
Reyataz can be taken with H2 blockers—as long as they’re
taken as far apart as possible. Dr. Wohlfeiler echoes Young’s concerns
and adds, “PPIs may be even worse than the H2 blockers in terms of
reducing drug levels of Reyataz. At one time, it was believed that
boosting Reyataz with Norvir may deal with this unwanted interaction
but this appears not to be the case. Reyataz is not being broken down
precisely because the PPIs are very effective at blocking production of
stomach acid at the source.”
Powerful Options Treating HIV
and your tummy problems is possible. “I would think first in terms of
drugs such as Kaletra and Lexiva if the patient is known to have
serious problems with stomach acid,” says Dr. Young. He cited one
combination recently studied in a Phase IV clinical trial and found to
be safe—the gastric modifier, Nexium, and the protease inhibitor,
Lexiva (which also appears to be safe with most H2 blockers). Nexium
was found to have no significant effect on blood levels of Lexiva in 48
patients. Dr. Wohlfeiler would consider a range of alternative PIs,
except for Reyataz, based on the individual needs and problems of the
patient.
Recently, he confronted a dilemma with a patient who
really liked Reyataz’s one-a-day dosing. “I gave him a choice of
staying on Reyataz and switching to taking Zantac twelve hours apart
from his PI,” he says. “But he was fearful of debilitating heartburn.”
So he switched the patient to Sustiva.
