May 15, 2002
Out of the available and tested p.i.'s which seen to have the least side effects,and which the most?I read that viracept is "the baby asprin p.i" in terms of side effects, and if you don't experience the diarreaha you'll be in good shape.Does this mean less liver toxcity,possible lipo ect?Also,are there any new p.i's coming out soon that are "kinder and gentler" and can be used if you have some p.i. ressistance?Didn't show any,but always want to be prepared for the worst. Also,must you boost a p.i. with norvir?
Response from Dr. Henry
To properly answer your good questions would take a very long time. The optimal PI for a given patients depends on a number of factors (individualized) including prior treatment history, hi and low CD4/HIV RNA values,other medical problems, work/sleep schedules, etc. Viracept is often well tolerated but is not free of lipid/fat problems. Atazanavir (the new BMS PI) will soon be available and appears to have less effect of plasma lipids (though increases in bilirubin are often seen) and is a well tolerated once a day PI. To optimize convenience and potency, ritonavir boosted PIs are very popular. The trade off is more elevations in plasma lipids. Thus there is no one size fits all approach to PI use. For new patients with no prior treatment history, when I use a PI in the initial regimen I often will switch to a simpler non-PI containing regimen after an initial phase of use when the treatment objective (undetectable HIV level) has been achieved. KH
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