A review of dual protease inhibitor therapy.

The 1998 Retrovirus Conference in Chicago presented what is known about specific dual-protease inhibitor (PI) therapies. The effectiveness of the following therapies are highlighted: ritonavir/saquinavir, nelfinavir/saquinavir, ritonavir/indinavir, indinavir/saquinavir, amprenavir in dual-protease inhibitor combinations, and ABT-378/ritonavir. Growing evidence supports the use of dual PIs in treating HIV disease. Effectiveness is enhanced when they are combined with reverse transcriptase inhibitors. Ritonavir/saquinavir is the therapy of choice so far, particularly for salvage therapy. Less support is found for nelfinavir/saquinavir, following the failure of other PIs. Failure on dual PI therapy is likely to cause extensive cross-resistance within the PI class. Therefore, caution is warranted in using dual PI therapy in patients who have problems with adherence.