Overview of boosted protease inhibitors in treatment-experienced HIV-infected patients
Antiretroviral drug combinations that include two nucleoside reverse transcriptase inhibitors and a protease inhibitor (PI) can suppress HIV replication to undetectable levels, improving the prognosis of HIV-infected individuals. The aim of therapy is complete virological suppression, with a current...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2007-12, Vol.60 (6), p.1195-1205 |
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| container_title | Journal of antimicrobial chemotherapy |
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| creator | Youle, Mike |
| description | Antiretroviral drug combinations that include two nucleoside reverse transcriptase inhibitors and a protease inhibitor (PI) can suppress HIV replication to undetectable levels, improving the prognosis of HIV-infected individuals. The aim of therapy is complete virological suppression, with a current goal of |
| doi_str_mv | 10.1093/jac/dkm364 |
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The aim of therapy is complete virological suppression, with a current goal of <50 copies/mL HIV-1 RNA, in order to minimize the occurrence of drug resistance. Improved understanding of the pharmacology of PIs, primarily the importance of adequate drug exposure, has led to the widespread administration of PIs combined with a low ‘boosting’ dose of ritonavir. The combination of PIs with ritonavir can improve treatment responses in both treatment-naive and -experienced patients. Boosted PIs are an important therapeutic option for HIV and extensive data exist supporting their use. Use of individual agents should be guided by a resistance test at all stages of treatment from naive through to highly treatment-experienced patients. Currently, seven boosted PIs have both US and European licensing approval: indinavir, saquinavir, lopinavir, fosamprenavir, atazanavir, tipranavir and darunavir (formerly TMC114). The preferred first-line option in the USA is lopinavir. Many of the older PIs are less effective and/or have less favourable tolerability profiles. Emergent PI resistance is a major challenge in treatment, and it can be accelerated by partial suppression of viral load through inappropriate therapy combinations. Using the newer boosted PIs, which have more robust resistance profiles, with an optimized background regimen may increase the likelihood of complete viral suppression. This review discusses the relative strengths and weaknesses of boosted PIs in current practice.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkm364</identifier><identifier>PMID: 17890281</identifier><identifier>CODEN: JACHDX</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral drugs ; antiretroviral therapy ; antiviral ; Biological and medical sciences ; Biomedical research ; Drug Resistance, Viral - genetics ; Drug Therapy, Combination ; Europe ; HIV ; HIV Infections - drug therapy ; HIV Infections - virology ; HIV Protease - drug effects ; HIV Protease - genetics ; HIV Protease Inhibitors - administration & dosage ; HIV Protease Inhibitors - classification ; HIV Protease Inhibitors - therapeutic use ; HIV-1 - drug effects ; HIV-1 - enzymology ; HIV-1 - genetics ; Human immunodeficiency virus ; Human immunodeficiency virus 1 ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Medical prognosis ; Medical sciences ; Microbiology ; Pharmacology ; Pharmacology. Drug treatments ; PIs ; Protease inhibitors ; Randomized Controlled Trials as Topic ; Ritonavir - administration & dosage ; Ritonavir - therapeutic use ; Treatment Outcome ; United States ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>Journal of antimicrobial chemotherapy, 2007-12, Vol.60 (6), p.1195-1205</ispartof><rights>The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2007</rights><rights>2008 INIST-CNRS</rights><rights>The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. 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The aim of therapy is complete virological suppression, with a current goal of <50 copies/mL HIV-1 RNA, in order to minimize the occurrence of drug resistance. Improved understanding of the pharmacology of PIs, primarily the importance of adequate drug exposure, has led to the widespread administration of PIs combined with a low ‘boosting’ dose of ritonavir. The combination of PIs with ritonavir can improve treatment responses in both treatment-naive and -experienced patients. Boosted PIs are an important therapeutic option for HIV and extensive data exist supporting their use. Use of individual agents should be guided by a resistance test at all stages of treatment from naive through to highly treatment-experienced patients. Currently, seven boosted PIs have both US and European licensing approval: indinavir, saquinavir, lopinavir, fosamprenavir, atazanavir, tipranavir and darunavir (formerly TMC114). The preferred first-line option in the USA is lopinavir. Many of the older PIs are less effective and/or have less favourable tolerability profiles. Emergent PI resistance is a major challenge in treatment, and it can be accelerated by partial suppression of viral load through inappropriate therapy combinations. Using the newer boosted PIs, which have more robust resistance profiles, with an optimized background regimen may increase the likelihood of complete viral suppression. This review discusses the relative strengths and weaknesses of boosted PIs in current practice.</description><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral drugs</subject><subject>antiretroviral therapy</subject><subject>antiviral</subject><subject>Biological and medical sciences</subject><subject>Biomedical research</subject><subject>Drug Resistance, Viral - genetics</subject><subject>Drug Therapy, Combination</subject><subject>Europe</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - virology</subject><subject>HIV Protease - drug effects</subject><subject>HIV Protease - genetics</subject><subject>HIV Protease Inhibitors - administration & dosage</subject><subject>HIV Protease Inhibitors - classification</subject><subject>HIV Protease Inhibitors - therapeutic use</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - enzymology</subject><subject>HIV-1 - genetics</subject><subject>Human immunodeficiency virus</subject><subject>Human immunodeficiency virus 1</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Microbiology</subject><subject>Pharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>PIs</subject><subject>Protease inhibitors</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Ritonavir - administration & dosage</subject><subject>Ritonavir - therapeutic use</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious diseases</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Microbiology</topic><topic>Pharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>PIs</topic><topic>Protease inhibitors</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Ritonavir - administration & dosage</topic><topic>Ritonavir - therapeutic use</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Youle, Mike</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Youle, Mike</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Overview of boosted protease inhibitors in treatment-experienced HIV-infected patients</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2007-12-01</date><risdate>2007</risdate><volume>60</volume><issue>6</issue><spage>1195</spage><epage>1205</epage><pages>1195-1205</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><coden>JACHDX</coden><abstract>Antiretroviral drug combinations that include two nucleoside reverse transcriptase inhibitors and a protease inhibitor (PI) can suppress HIV replication to undetectable levels, improving the prognosis of HIV-infected individuals. 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Many of the older PIs are less effective and/or have less favourable tolerability profiles. Emergent PI resistance is a major challenge in treatment, and it can be accelerated by partial suppression of viral load through inappropriate therapy combinations. Using the newer boosted PIs, which have more robust resistance profiles, with an optimized background regimen may increase the likelihood of complete viral suppression. This review discusses the relative strengths and weaknesses of boosted PIs in current practice.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17890281</pmid><doi>10.1093/jac/dkm364</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral drugs antiretroviral therapy antiviral Biological and medical sciences Biomedical research Drug Resistance, Viral - genetics Drug Therapy, Combination Europe HIV HIV Infections - drug therapy HIV Infections - virology HIV Protease - drug effects HIV Protease - genetics HIV Protease Inhibitors - administration & dosage HIV Protease Inhibitors - classification HIV Protease Inhibitors - therapeutic use HIV-1 - drug effects HIV-1 - enzymology HIV-1 - genetics Human immunodeficiency virus Human immunodeficiency virus 1 Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Medical prognosis Medical sciences Microbiology Pharmacology Pharmacology. Drug treatments PIs Protease inhibitors Randomized Controlled Trials as Topic Ritonavir - administration & dosage Ritonavir - therapeutic use Treatment Outcome United States Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Overview of boosted protease inhibitors in treatment-experienced HIV-infected patients |
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