| Regimen |
Possible Advantages |
Possible Disadvantages |
Drug-Interaction Complications |
Impact on FutureOptions |
| PI-based HAARTRegimen (NNRTI- and FI-sparing) |
Clinical, virologic, andimmunologic efficacy well-documented
# Resistance requires multiple mutations
# Avoid NNRTI and FI-associated side effects
# Targets HIV at two steps of viral replication (RT and PI) |
Some regimens are difficult to use and adhere to
¦ Long-term side effects ofteninclude lipodystrophy*, hyperlipidemia and insulin resistance |
Mild to severe inhibition of cytochrome P450 pathway; Ritonavir is most potent inhibitor, (but this effect can be exploited to boost levels of other PIs) |
Preserves NNRTIs and FI for use intreatment failure. Resistance primes for cross-resistance with other PIs |
| NNRTI-basedHAART regimen (PI- and FI-sparing) |
Virologic, and immunologic efficacy well-documented.
Spares PI & FI-related side effects
Easier to use and adhere to, compared with most PI regimens |
Resistance conferred by asingle or limited number ofmutations |
Fewer drug interactions compared with PIs |
Preserves PIs and FI for use in treatment failure
Resistance usually leads to cross-resistance across entire NNRTI class |
| Triple NRTI regimen(NNRTI- andPI-sparing) |
Generally easier to use and adhere to compared with PIs
Sparing PI, NNRTI, and FIside effects |
Inferior virologic efficacy |
No cytochrome P450 interaction |
Preserves PI, NNRTI and FI classes foruse in treatment failure |
* Some side effects being attributed to PI therapy, such as lipodystrophy, have not been proven to the strictly associated with the use of PI-containing regimens. Lipodystrophy has also been described among patients on NRTIs alone (especially stavudine) and in patients on no antiretroviral therapy.
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