Boosted Protease Inhibitor-Based or Nonnucleoside Reverse Transcriptase-Based HAART: Is There a Best Choice for Antiretroviral-Naive HIV-1 Infected Patients?

Since 1996 and the introduction of highly active antiretroviral therapies, multiple drugs have been developed.The best choice of drugs to start with still remains debated, especially regarding the choice betweenprotease inhibitor-based or nonnucleoside reverse transcriptase inhibitor-based regimens. Regarding theregimen’s ability to control viral replication, both have been proven to be very efficient in large settingsof patients. Regarding short-term tolerability, both classes are responsible for various side effects in10-25% of patients. Regarding long-term tolerability, protease inhibitor-based regimens may be responsiblefor metabolism abnormalities (hypertriglyceridemia, diabetes), although the role of the associatednucleoside reverse transcriptase inhibitor is not always clear. Patient adherence to the regimen is thecornerstone of efficacy. Resistance acquisition in case of poor adherence leading to treatment failure isa key issue regarding the ability to build future efficient regimens. Failure while using protease inhibitorbasedregimens seldom leads to acquired resistance. Failure while using nonnucleoside reverse transcriptaseinhibitor-based regimens leads to resistance, but the new available nonnucleoside reversetranscriptase inhibitors do not share the same patterns of resistance, so that the well-known “class resistanceâ€?in case of nonnucleoside reverse transcriptase inhibitor failure is no longer valid. Drug-drug interactionsare frequent with all antiretrovirals and require close monitoring. In conclusion, protease inhibitorbasedand nonnucleoside reverse transcriptase inhibitor-based regimens each have many advantages.The best choice will essentially be made taking into account the patients’ characteristics.