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  • Title: Nelfinavir is number 4 -- but should it bat cleanup, or lead off?
    Author: Mascolini M.
    Journal: J Int Assoc Physicians AIDS Care; 1997 Jun; 3(6):17-21. PubMed ID: 11364427.
    Abstract:
    Critical issues are addressed concerning when to use nelfinavir, a newly approved protease inhibitor. Because of a resistance mutation that occurs as a result of taking nelfinavir, the following questions arise: if resistance emerges in a patient naive to protease inhibitor therapy, will that person be able to take another protease inhibitor without cross resistance occurring, and if resistant virus emerges after using another protease inhibitor, will subsequent use of nelfinavir offer any benefit? Much speculation has been made on these issues, based particularly on nelfinavir's causing mutation in an area of HIV protease not seen previously; therefore, some believe cross resistance will not occur to other protease inhibitors. One strategy is to combine nelfinavir with saquinavir -- not because it will necessarily inhibit HIV, but because it increases the blood level of saquinavir to higher levels. Clinical trials adding nelfinavir to other antiretroviral drugs showed dramatic decreases in viral load, but making comparisons to other drug regimens is difficult due to multiple differences between regimens. Some researchers believe that nelfinavir is similar to indinavir and ritonavir as far as antiretroviral efficacy. Nelfinavir is different because it penetrates the central nervous system. Nelfinavir does not have to be taken on as strict a schedule as other protease inhibitors, and should be taken with food. Certain drugs should not be taken with nelfinavir, such as the antihistamines astemizole and terfenadine, the motility agent cisapride, the benzodiazepines triazolam and midazolam, and the antimycobacterial agent, rifampin. When compared with other antiretrovirals, nelfinavir appears to be better tolerated with fewer toxic side effects.
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