Strategies for first line HIV therapy

May 2008     View PDF

Protease inhibitors

This class of drugs contains some of the most potent HIV drugs available. Other factors to consider when using them for first line therapy include their ease of use and possible long-term side effects.

There are a wide range of options. The Guidelines list three as preferred choices: Kaletra (lopinavir + ritonavir) twice a day, Reyataz boosted with Norvir (ritonavir), and boosted Lexiva (fosamprenavir) twice a day. Research shows them all to be potent and well tolerated for people on first line therapy.

The Guidelines also list five alternative PIs: unboosted Reyataz, unboosted Lexiva, boosted Lexiva once daily, Kaletra once daily, and boosted Invirase (saquinavir). In each case, there’s enough research to think that these should work well for most people taking HIV drugs for the first time. However, the research is either not as extensive or as favorable as for those listed as “preferred”.

Most PIs are highly potent. Some doctors prefer to save them if or when other less complicated regimens have failed. Although this may be an excellent strategy, not enough studies have yet been done to prove this is the best choice.