Antiviral Therapy 10:29–40 Review Nucleoside analogue-sparing strategy for the treatment of chronic HIV infection: potential interest and clinical experience Véronique Joly* and Patrick Yeni Maladies Infectieuses, Hôpital Bichat Claude Bernard, Paris, France *Corresponding author: Tel: +33 1 4025 7807; Fax: +33 1 4025 6775; E-mail:
[email protected] Nucleoside analogue-sparing antiretroviral combinations therapeutic drug monitoring service to confirm that appro- may be interesting as first-line therapies as they spare a priate drug exposures are achieved is useful when using complete class of drugs that will remain fully active for such regimens. Some negative kinetic interactions may lead later use and prevent the risk of mitochondrial toxicity to complicated combinations with a high pill burden that related to exposure to nucleoside reverse transcriptase reduces their applicability. Gastrointestinal toxicity often inhibitors (NRTIs). This strategy is also used in patients remains a limiting factor in the use of boosted double-PI failing NRTIs with cross-resistance to compounds in this combinations. Non-comparative studies have allowed class. Different combinations of antiretroviral drugs are selection of NRTI-sparing options that now need to be theoretically available. Non-nucleoside reverse transcrip- compared with the current standard of care in comparative tase inhibitors (NNRTIs) associated with protease inhibitor clinical trials before being considered as valuable options. (PI) and boosted double-PI combinations have been Other NRTI-sparing therapeutic strategies are emerging: studied through small, non-comparative clinical studies PI monotherapy with lopinavir/ritonavir has been evalu- and preliminary results suggest that they are efficient and ated in a small group of naive patients and appears often well-tolerated.