If it were you who was going to take protease
Oct 11, 2000
...inhibitors for the first time and you didn't have any lipodystrophy effects yet, which one would you take and why?, and also what other prevention actions would you take?, just imagine it was you with all you know ...., thank you.
Response from Dr. Young
This is a very important, and challenging question. My personal bias is to use nelfinavir as a single PI first. This is for several reasons. First, the drug is very well tolerated (for the most part) and god forbid, should there be viral failure and drug resistance, we understand which drugs are likely to work next. I have reservations still about the use of ritonavir-boosted regimens as initial therapy because of side effects, elevations in cholesterol and possible issues related to resistance after treatment failure. We need more studies (many are underway) to answer these questions. Overall, the choice is very personal; boosted PI's appear to have greater potency. This potency is offset by the possibility of greater side effects. Among the boosted PIs, we have great long-term data from RTV/SQV and RTV/lopinavir. There is also good data on RTV/IDV.
Benjamin Young, M.D., Ph.D.
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