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Protease Inhibitors - Do They Work?
Aug 3, 1996

My lover has been HIV possitive for the last six years. On his last Doctor's appointment his T-Cell Count was way down. He is the healthiest he has ever been, feels great, but has been under some stress as of the last few months. Could this be the cause for the low T cell count? Also,his doctor has put him on Protease Inhibitors. I understand that thereis a lot of optimism about these, but are they really working? He will start using them within the next month, should I be optimistic?

Response from Dr. Cohen

The reason for the optimism surrounding protease inhibitors is that they work very well, and the more we learn about them, the more enthusiastic we become. Data from the Vancouver conference clearly show that the protease inhibitors not only produce profound drops in viral load and elevations in T-cell counts, but that those changes last for a long time. We don't know the duration of that benefit yet, because they haven't been around long enough. But in theory if you can suppress viral replication to the degree that protease inhibitors do, then mutations will not occur, which means that resistance will not develop, which ultimately means that the benefit of the drugs should be long-lasting.

Of course, as I've said before, the protease inhibitors only work well when they're used properly. That means that they should always be used in combination with nucleoside analogs, preferably nucleosides that the patient has not been on before. Using them with the same drugs you've been on for years is essentially the same as using them alone. The benefit in such cases will be extremely brief. Protease inhibitors need to be taken at full dose and with almost religious regularity. Missing doses frequently or taking less than full doses will lead to the rapid development of resistance, which means drug failure.



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