Logical order in PI's?
Feb 25, 2006
In absence of previous treatments on PI's and based on the usual mutations that appear is there a "more logical order" when beginning a PI based treatment? (I'm speaking OF 908, KALETRA,REYATAZ)
Response from Dr. Wohl
This is a good question and one that can ignite quite a debate among HIV experts. My own thinking on this reflects the unique ability of ritonavir boosted PIs to be not only potent but also to be able to reduce the risk of PI resistance, even in those failing regimens that they are part of. In study after study of boosted PIs we see few people experiencing virologic failure. And, of those that do, typically none have PI resistance detected.
So, I feel, generally, one should start with the boosted PI that is likely to be best tolerated and adhered to and that there is little evidence to suggest an optimal sequence of PIs when boosted.
Whether to ever use atazanavir unboosted with ritonavir is a realted issue as resistance to this PI can be expected if failure ensures. In this case, you would need a potent salvage PI (Kaletra, tipranavir, TMC114) next. I do have patients for who unboosted atazanavir is ideal (bad lipid or diabetes problems, intolerance of ritonavir). Recall, atazanavir can not be taken without ritonavir in people also on tenofovir (due to drug interactions leading to reduced atazanavir levels) or on H2 blockers or drugs like Nexium.
Get Email Notifications When This Forum Updates or Subscribe With RSS
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.