Abstract
HIV-1 drug regimens now offer more potent, less toxic and more durable choices. However, strategies addressing convenient sequential use of active antiretroviral combinations are rarely presented in the literature. Studies have seldom directly addressed this issue, despite it being a matter of daily use in clinical practice. This is, in part, because of the complexity of HIV-1 resistance information. Nevertheless, several principles can effectively assist the planning of antiretroviral drug sequencing. The introduction of tenofovir, abacavir and emtricitabine into current nucleoside backbone options, with each of them selecting for an individual pattern of resistance mutations, now permits sequencing in the context of previously popular thymidine analogs (zidovudine and stavudine). Similarly, newer ritonavir-boosted protease inhibitors could be potentially sequenced in a manner that uses the least cross-resistance prone PI at the start of therapy while leaving the most cross-resistance prone drugs for later, as long as there is rationale to employ such a compound because of its utility against commonly observed drug-resistant forms of the virus. The ability to sequence new therapies will be enhanced by availability of new antiretroviral drugs.
Keywords: Protease inhibitors, nucleoside-reverse transcriptase inhibitors, nucleotide-reverse transcriptase inhibitor, antiretroviral sequencing, sequential antiretroviral therapy, HIV, cross-resistance, mutations, genetic barrier, salvage therapy
Infectious Disorders - Drug Targets
Title: Sequencing of Therapy to Avoid Resistance and the Need for New Antiretroviral Drugs in the Treatment of HIV Disease
Volume: 9 Issue: 2
Author(s): Mark A. Wainberg and Jorge L. Martinez-Cajas
Affiliation:
Keywords: Protease inhibitors, nucleoside-reverse transcriptase inhibitors, nucleotide-reverse transcriptase inhibitor, antiretroviral sequencing, sequential antiretroviral therapy, HIV, cross-resistance, mutations, genetic barrier, salvage therapy
Abstract: HIV-1 drug regimens now offer more potent, less toxic and more durable choices. However, strategies addressing convenient sequential use of active antiretroviral combinations are rarely presented in the literature. Studies have seldom directly addressed this issue, despite it being a matter of daily use in clinical practice. This is, in part, because of the complexity of HIV-1 resistance information. Nevertheless, several principles can effectively assist the planning of antiretroviral drug sequencing. The introduction of tenofovir, abacavir and emtricitabine into current nucleoside backbone options, with each of them selecting for an individual pattern of resistance mutations, now permits sequencing in the context of previously popular thymidine analogs (zidovudine and stavudine). Similarly, newer ritonavir-boosted protease inhibitors could be potentially sequenced in a manner that uses the least cross-resistance prone PI at the start of therapy while leaving the most cross-resistance prone drugs for later, as long as there is rationale to employ such a compound because of its utility against commonly observed drug-resistant forms of the virus. The ability to sequence new therapies will be enhanced by availability of new antiretroviral drugs.
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Cite this article as:
Wainberg A. Mark and Martinez-Cajas L. Jorge, Sequencing of Therapy to Avoid Resistance and the Need for New Antiretroviral Drugs in the Treatment of HIV Disease, Infectious Disorders - Drug Targets 2009; 9 (2) . https://dx.doi.org/10.2174/187152609787847668
DOI https://dx.doi.org/10.2174/187152609787847668 |
Print ISSN 1871-5265 |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-3989 |
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