Sequencing of protease inhibitor therapy: Insights from an analysis of HIV phenotypic resistance in patients failing protease inhibitors [Kemper CA, et al. AIDS 2001;15:609]: This is a report from the California Collaborative Treatment Group #575 Team. The analysis concerned 88 patients who had virologic failure (viral loads exceeding 400 c/ml) after at least six months of antiretroviral therapy including use of a PI for at least three months. Phenotypic resistance was defined as an increase in IC50 exceeding 2.5-fold compared to wild-type virus. Of the 88 HIV strains, 18% were pan-sensitive to PIs, and 8% were pan-resistant. Isolates from patients receiving nelfinavir were less likely to have resistance to other PIs (P < 0.001); the difference persisted after adjustment for duration of PI use.
Comment: This study is one of several supporting the concept that initial PI therapy with nelfinavir is less likely to limit future PI options than other PIs. Similar results have been observed with amprenavir, but there were too few patients in the current report to examine this agent.
posted 4/25/2001

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