This sudden expansion of the armamentarium of drugs for HIV is viewed as a major breakthrough for HIV therapeutics. It is also a time of great confusion for care providers since the experience with the new drugs and drug combinations is limited, the cost is high and guidelines are limited.
Several issues are important to emphasize in terms of both guidelines and gaps in knowledge.
Indinavir has the advantage of better GI tolerance. Ritonavir has an extraordinarily complicated list of drug interactions due to profound inhibition of cytochrome P450 isoforms. Monotherapy Most authorities feel that single drug treatment of HIV infection is passe. Nevertheless, there are some patients who have done well with monotherapy drug treatment in the past, and many authorities see little reason to change regimens in such patients. In addition, there are some patients who will simply not be able to comply with the complexity or support the cost of combination treatment.