Dual protease inhibitor therapy in HIV-infected patients: Pharmacologic rationale and clinical benefits

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94 Scopus citations


HIV protease inhibitors, as components of combination antiretroviral drug regimens, have substantially reduced the morbidity and mortality associated with HIV infection. They selectively block the action of the virus-encoded protease and stop the virus from replicating. In general, these drugs have poor systemic bioavailability and must be dosed with respect to meals for optimal absorption. Protease inhibitor-containing regimens require ingestion of a large number of capsules, are costly, and produce or are susceptible to metabolic drug interactions. Simultaneous administration of two protease inhibitors takes advantage of beneficial pharmacokinetic interactions and may circumvent many of the drugs' undesirable pharmacologic properties. For example, ritonavir increases saquinavir concentrations at steady state by up to 30-fold, allowing reduction of saquinavir dose and dosing frequency. Ritonavir decreases the systemic clearance of indinavir and overcomes the deleterious effect of food on indinavir bioavailability. These benefits reflect inhibition of presystemic clearance and first-pass metabolism; as well as inhibition of systemic clearance mediated by hepatic cytochrome P450 3A4. Several dual protease inhibitor combination regimens have shown great promise in clinical trials and are now recommended as components of salvage therapy for HIV-infected patients.

Original languageEnglish (US)
Pages (from-to)649-674
Number of pages26
JournalAnnual Review of Pharmacology and Toxicology
StatePublished - Jan 1 2000


  • Cytochrome P450
  • Drug interactions
  • P- glycoprotein
  • Pharmacodynamics
  • Pharmacokinetics

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology


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