Considerations in selecting protease inhibitor therapy

Over the past 10 years, highly active antiretroviral therapy that included a protease inhibitor has played a significant role in reducing morbidity and mortality among HIV-infected individuals. The early protease inhibitors were associated, however, with some significant limitations that posed major obstacles to their use--limited potency, difficult side effects, high regimen complexity and potential for cross-resistance. Important advances in the protease inhibitor class, including ritonavir boosting and the approval of two new protease inhibitors with the potential for once daily dosing, have led to simpler, better-tolerated protease-inhibitor therapy with the potential for improved efficacy, less toxicity and a reduced risk of the development of HIV resistance. Protease inhibitor characteristics and patient preferences should be considered in selecting the protease inhibitor that maximizes the opportunity for long-term efficacy and tolerability of highly active antiretroviral therapy.