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Managing HIV/AIDS Therapy in Treatment-Experienced Patients
When do you switch out a PI-based regimen?
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Dr. Kwakwa (OC): Well, one main factor in switching from a PI-based regimen-as a form of treatment for some of the longer-term toxicities that may develop on a PI-based regimen, such as dyslipidemias, and there have been several switch studies that show that switching to the non-nucleoside-based regimens in such people certainly has some benefit.
Dr. Wohlfeiler (OC): Even if you don't have the benefit of resistance testing, you know that there are certain rules that you can use to know what's likely to work after failure of a certain medication. For instance, with protease inhibitor based regimens, if you fail a nelfinavir-based regimen, you know that pretty much you can use any other protease after that. And so those kinds of rules figure into it and help you make decisions.
Dr. Bellos (OC): For example, if you have a specific PI that may have one or two mutations, it may now be 60% efficacious, versus 100% efficacious. Is that something you couldn't use in a future regimen? No. That's something where if it wasn't affecting the replicative capacity of the virus, you could continue to use it in the regimen.
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