Sequencing antiretroviral drugs for long-lasting suppression of HIV replication

Nicola Gianotti, Adriano Lazzarin

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

The primary goal of antiretroviral sequencing is to extend maximal viral suppression for as long as possible by avoiding the selection of a multidrug-resistant virus. It is likely that lamivudine or emtricitabine will be an unavoidable component of any initial regimen because of their efficacy, tolerability and convenience of administration. The risk of selecting a nucleotide excision or the 65R mutations is minimised with abacavir plus lamivudine or tenofovir plus emtricitabine when they are combined with boosted protease inhibitors (PIs) or efavirenz. These dual-nucleoside reverse transcriptase inhibitor backbones (NRTIs) also have the major advantage of their low potential for mitochondrial toxicity, which may contribute to the long-lasting suppression of viral replication by avoiding treatment interruptions due to drug toxicity. Neither PIs nor non-NRTIs (NNRTIs) cause mitochondrial injury, but the initial use of boosted PIs has the advantages of avoiding the selection of class-resistant variants and reducing the risk of selecting for NRTI resistance, thus preserving a wider range of subsequent treatment options. Although the question is still controversial, NNRTIs may best be used as second-line options in both simplification and salvage regimens. The optimal timing for starting entry inhibitors during the course of HIV disease has not yet been fully elucidated.

Original languageEnglish
Pages (from-to)281-297
Number of pages17
JournalNew Microbiologica
Volume28
Issue number4
Publication statusPublished - Oct 2005

Fingerprint

Reverse Transcriptase Inhibitors
Protease Inhibitors
Tenofovir
efavirenz
HIV
Nucleosides
Pharmaceutical Preparations
Lamivudine
Drug-Related Side Effects and Adverse Reactions
Nucleotides
Viruses
Mutation
Wounds and Injuries
Emtricitabine

Keywords

  • Antiretroviral sequencing
  • Drug resistance
  • HAART
  • HIV-1
  • Mitochondrial toxicity

ASJC Scopus subject areas

  • Microbiology (medical)
  • Microbiology

Cite this

Sequencing antiretroviral drugs for long-lasting suppression of HIV replication. / Gianotti, Nicola; Lazzarin, Adriano.

In: New Microbiologica, Vol. 28, No. 4, 10.2005, p. 281-297.

Research output: Contribution to journalArticle

@article{ad427aa114b54156be48b082c0a2fb78,
title = "Sequencing antiretroviral drugs for long-lasting suppression of HIV replication",
abstract = "The primary goal of antiretroviral sequencing is to extend maximal viral suppression for as long as possible by avoiding the selection of a multidrug-resistant virus. It is likely that lamivudine or emtricitabine will be an unavoidable component of any initial regimen because of their efficacy, tolerability and convenience of administration. The risk of selecting a nucleotide excision or the 65R mutations is minimised with abacavir plus lamivudine or tenofovir plus emtricitabine when they are combined with boosted protease inhibitors (PIs) or efavirenz. These dual-nucleoside reverse transcriptase inhibitor backbones (NRTIs) also have the major advantage of their low potential for mitochondrial toxicity, which may contribute to the long-lasting suppression of viral replication by avoiding treatment interruptions due to drug toxicity. Neither PIs nor non-NRTIs (NNRTIs) cause mitochondrial injury, but the initial use of boosted PIs has the advantages of avoiding the selection of class-resistant variants and reducing the risk of selecting for NRTI resistance, thus preserving a wider range of subsequent treatment options. Although the question is still controversial, NNRTIs may best be used as second-line options in both simplification and salvage regimens. The optimal timing for starting entry inhibitors during the course of HIV disease has not yet been fully elucidated.",
keywords = "Antiretroviral sequencing, Drug resistance, HAART, HIV-1, Mitochondrial toxicity",
author = "Nicola Gianotti and Adriano Lazzarin",
year = "2005",
month = "10",
language = "English",
volume = "28",
pages = "281--297",
journal = "New Microbiologica",
issn = "1121-7138",
publisher = "Luigi Ponzio e figlio Editori",
number = "4",

}

TY - JOUR

T1 - Sequencing antiretroviral drugs for long-lasting suppression of HIV replication

AU - Gianotti, Nicola

AU - Lazzarin, Adriano

PY - 2005/10

Y1 - 2005/10

N2 - The primary goal of antiretroviral sequencing is to extend maximal viral suppression for as long as possible by avoiding the selection of a multidrug-resistant virus. It is likely that lamivudine or emtricitabine will be an unavoidable component of any initial regimen because of their efficacy, tolerability and convenience of administration. The risk of selecting a nucleotide excision or the 65R mutations is minimised with abacavir plus lamivudine or tenofovir plus emtricitabine when they are combined with boosted protease inhibitors (PIs) or efavirenz. These dual-nucleoside reverse transcriptase inhibitor backbones (NRTIs) also have the major advantage of their low potential for mitochondrial toxicity, which may contribute to the long-lasting suppression of viral replication by avoiding treatment interruptions due to drug toxicity. Neither PIs nor non-NRTIs (NNRTIs) cause mitochondrial injury, but the initial use of boosted PIs has the advantages of avoiding the selection of class-resistant variants and reducing the risk of selecting for NRTI resistance, thus preserving a wider range of subsequent treatment options. Although the question is still controversial, NNRTIs may best be used as second-line options in both simplification and salvage regimens. The optimal timing for starting entry inhibitors during the course of HIV disease has not yet been fully elucidated.

AB - The primary goal of antiretroviral sequencing is to extend maximal viral suppression for as long as possible by avoiding the selection of a multidrug-resistant virus. It is likely that lamivudine or emtricitabine will be an unavoidable component of any initial regimen because of their efficacy, tolerability and convenience of administration. The risk of selecting a nucleotide excision or the 65R mutations is minimised with abacavir plus lamivudine or tenofovir plus emtricitabine when they are combined with boosted protease inhibitors (PIs) or efavirenz. These dual-nucleoside reverse transcriptase inhibitor backbones (NRTIs) also have the major advantage of their low potential for mitochondrial toxicity, which may contribute to the long-lasting suppression of viral replication by avoiding treatment interruptions due to drug toxicity. Neither PIs nor non-NRTIs (NNRTIs) cause mitochondrial injury, but the initial use of boosted PIs has the advantages of avoiding the selection of class-resistant variants and reducing the risk of selecting for NRTI resistance, thus preserving a wider range of subsequent treatment options. Although the question is still controversial, NNRTIs may best be used as second-line options in both simplification and salvage regimens. The optimal timing for starting entry inhibitors during the course of HIV disease has not yet been fully elucidated.

KW - Antiretroviral sequencing

KW - Drug resistance

KW - HAART

KW - HIV-1

KW - Mitochondrial toxicity

UR - http://www.scopus.com/inward/record.url?scp=29244451381&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=29244451381&partnerID=8YFLogxK

M3 - Article

C2 - 16386013

AN - SCOPUS:29244451381

VL - 28

SP - 281

EP - 297

JO - New Microbiologica

JF - New Microbiologica

SN - 1121-7138

IS - 4

ER -