The protease inhibitors

Abstract

With the advent of newer antiretroviral agents for the treatment of patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS), health care providers are faced with many options to optimize their patients’ therapy. Currently, there are three groups of drugs available for the treatment of patients with HIV infection: nucleoside reverse transcriptase inhibitors (also known as nucleoside analogues), nonnucleoside reverse transcriptase inhibitors, and protease inhibitors (PIs). The preferred initial treatment regimen now consists of two nucleoside analogues and a PI. Protease inhibitors cause profound and sustained suppression of viral replication, increase time to first AIDS-defining illness, and reduce mortality. Each of the available PIs have distinct pharmacokinetic and metabolic properties that result in different dosing regimens and potential for interactions with food and other drugs. Patients with HIV infection typically receive several drugs; therefore, convenience of administration, optimal side-effect profile, and cost of the agents must also be considered along with the potential for drug interactions. A growing proportion of HIV patients worldwide are women. HIV-infected pregnant women should be offered antiretroviral prophylaxis to prevent perinatal HIV transmission as well as to optimize their own health. Zidovudine (ZDV) treatment has been the standard antiretroviral treatment during pregnancy; however, recent data has shown that combination regimens produce a more pronounced antiviral effect and may be more effective than ZDV monotherapy in preventing perinatal HIV transmission.