Aug 17, 2009
Why is Ritonavir boosted Prezista considered a preferred treatment choice in naive patients? If I develop resistance to it, my understanding is that I will develop resistance to all other PI's besides Aptivus at the same time and therefore would 'knock-out' a whole drug class for future use. Why wouldn't I therefore start treatment with a different PI to keep my options open in the long run?
Response from Dr. McGowan
Thanks for your question.
There have been 2 schools of thought on this subject, the "suppressors" and the "sequencers". Most treatment failures with boosted PI regimens fail without the development of PI resistant virus, and even if mutations are seen they are unlikely to cause cross resistance to all the PIs. The suppressors argument is that you should plan to use the best options up front and avoid the need for second line treatment. If you do not miss doses your chances of developing a drug resistant virus with a powerful initial combo are rare.
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