Evidence from the only national random sample of HIV patients (the HIV Cost and Services Utilization Study--HCSUS) also found that women were less likely to receive therapies involving protease inhibitors or nonnucleoside reverse transcriptase inhibitors
(therapy involving these drugs is often referred to as highly active antiretroviral therapy or HAART) immediately after their diffusion (Shapiro et al.
More recent microbicide approaches include blocking viral entry using polyanionic compounds that interact with the positively charged areas of the viral envelope proteins, blocking HIV uptake receptors in cells to prevent viral attachment to mucosal surfaces, and the use of nonnucleoside reverse transcriptase inhibitors
in products to inhibit viral replication.
These are categorized by drug class: nucleoside analogs, nonnucleoside reverse transcriptase inhibitors
, and protease inhibitors.
Nonnucleoside reverse transcriptase inhibitors
(NNRTIs) are a potent component in salvage therapy.
In addition to the protease inhibitors and the nonnucleoside reverse transcriptase inhibitors
(or NNRTIs), new and more powerful second-generation nucleoside analogues (such as lamivudine-3TC) are now also available.
The panel concluded that other effective regimens may include nonnucleoside reverse transcriptase inhibitors
or boosted protease inhibitors with two NRTIs.
The survey, which looked at specimens from 3,130 newly diagnosed, drug-naive individuals, found that 4% of infections had mutations conferring resistance to nucleoside reverse transcriptase inhibitors, 7% to nonnucleoside reverse transcriptase inhibitors
, and 2% to protease inhibitors.
Although the idea of combining three nucleoside reverse transcriptase inhibitors seemed appealing as a way to spare patients some of the toxicities of nonnucleoside reverse transcriptase inhibitors
or protease inhibitors, once-daily triple-nucleoside combinations that lacked zidovudine (AZT) often failed because of gene mutations, which were infrequently seen in the past when nearly every regimen contained AZT, investigators reported at the meeting.
They conducted a retrospective chart review from 41 PI experienced patients, which revealed that 73% were also experienced with nonnucleoside reverse transcriptase inhibitors