title: The insufficient suppression of viral load by saquinavir hard gel is reversible: a retrospective cohort study.
abstract: OBJECTIVE
  To assess the effect of changing antiretroviral therapy in patients initially treated with saquinavir hard gel capsule (hgc).
  
  
  METHODS
  A retrospective cohort study comparing the virological and immunological responses in antiretroviral-naïve patients initially treated with a regimen of saquinavir-hgc, zidovudine, and lamivudine, with patients receiving either ritonavir or indinavir on a background of zidovudine and lamivudine.
  
  
  RESULTS
  Twenty-nine patients starting with saquinavir-hgc as the protease inhibitor (PI) component were compared to 58 patients starting with ritonavir (n = 16) or indinavir (n = 42). Median follow-up time was 30 and 33 months, respectively. Twelve, 18, 24, and 30 months after starting a regimen including saquinavir-hgc, 72%, 50%, 4%, and 0% of patients still received this PI. At these time points, 35%, 24%, 59%, and 74% of the patients in the saquinavir group obtained an HIV-RNA <500 copies/mL compared to 76%, 72%, 66%, and 65% in the indinavir/ritonavir group. No significant difference in CD4 count between the two groups was observed.
  
  
  CONCLUSIONS
  We found that saquinavir-hgc, in combination with nucleoside reverse transcriptase inhibitors, suppressed viral load insufficiently in HIV patients naïve to antiretroviral therapy. However, the suboptimal effect of saquinavir-hgc seems reversible after optimizing the antiretroviral regimen, at least for the short term.
authors.affiliation: Department of Infectious Diseases, Marselisborg Hospital, Aarhus University Hospital, Denmark. fangel@dadlnet.dk
authors.forename: S
authors.initials: S
authors.lastname: Jensen-Fangel
authors.forename: O
authors.initials: O
authors.lastname: Kirk
authors.forename: A
authors.initials: A
authors.lastname: Blaxhult
authors.forename: J
authors.initials: J
authors.lastname: Gerstoft
authors.forename: C
authors.initials: C
authors.lastname: Pedersen
authors.forename: F T
authors.initials: FT
authors.lastname: Black
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: N
authors.initials: N
authors.lastname: Obel
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002214:Capsules / Q000008:administration & dosage; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005780:Gelatin; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D019258:Saquinavir / Q000627:therapeutic use*; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D002214:Capsules; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D005780:Gelatin; D019258:Saquinavir