Simplification strategies to reduce antiretroviral drug exposure

Progress and prospects

John E. McKinnon, John W. Mellors, Susan Swindells

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

Current US guidelines for initial therapy of HIV type-1 (HIV-1) infection recommend daily, lifelong treatment with a combination of three antiretroviral drugs consisting of two nucleoside analogue reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. Although this approach has been successful in reducing morbidity and mortality from HIV-1 infection, concerns remain about adverse events from chronic drug exposure, the requirement for daily medication adherence, the risk of HIV-1 drug resistance and high treatment costs. The availability of antiretrovirals that are coformulated and dosed once daily have reduced pill burden and have simplified dosing schedules, but have not lowered drug exposure or cost. These limitations have stimulated research into drug-sparing strategies including intermittent therapy and simplified maintenance regimens. Randomized clinical trials have shown greater mortality with intermittent therapy compared with continuous therapy leading to rejection of this strategy. Pilot studies of simplified maintenance therapy with a ritonavirboosted protease inhibitor alone have shown more promise, although concerns remain. This article reviews progress in the simplification of antiretroviral therapy, recent clinical trial results and prospects for the future.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalAntiviral Therapy
Volume14
Issue number1
StatePublished - Mar 16 2009

Fingerprint

Pharmaceutical Preparations
HIV-1
Reverse Transcriptase Inhibitors
Protease Inhibitors
HIV Infections
Therapeutics
Medication Adherence
Mortality
Drug-Related Side Effects and Adverse Reactions
Nucleosides
Drug Resistance
Health Care Costs
Appointments and Schedules
Randomized Controlled Trials
Maintenance
Clinical Trials
Guidelines
Morbidity
Costs and Cost Analysis
Research

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Simplification strategies to reduce antiretroviral drug exposure : Progress and prospects. / McKinnon, John E.; Mellors, John W.; Swindells, Susan.

In: Antiviral Therapy, Vol. 14, No. 1, 16.03.2009, p. 1-12.

Research output: Contribution to journalReview article

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