Failure of HIV-1 Protease Inhibitors to Fully Suppress Viral Replication

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Abstract
HIV-1 protease inhibitors have had a dramatic impact on the management of HIV disease.1 As part of an aggressive three-drug combination, protease inhibitor therapy results in durable, potent suppression of viral replication. Recent data, however, indicates that a significant proportion of patients may not achieve long-term viral suppression.2,3,4 The prognostic implications of protease inhibitor drug failure, and its clinical management, remain unknown. This chapter will review the clinical characteristics and genotypic resistance patterns associated with each of the protease inhibitors, and then discuss the limited clinical data addressing drug failure and salvage therapy.