HIV protease inhibitors: recent clinical trials and recommendations on use

Background: HIV protease inhibitors (Pis) are potent antiretroviral drugs that represent a pivotal component of highly active antiretroviral therapy (HAART). Pis have evolved over the years to gain in potency, convenience, tolerability and genetic barrier to resistance. Objective: Updated summary of evidence-based information about the efficacy and safety of Pis on initial, simplification and rescue interventions in HIV patients. Methods: Review of available data reported in peer-reviewed journals, medical conferences and treatment guidelines. Results: Due to their characteristics, Pis are, and will remain, a cornerstone component in most lines of antiretroviral therapy. The antiviral activity, tolerability and convenience of Pis have improved significantly in recent years. Differences between compounds within this class may favour their use in specific situations, such as the friendly metabolic profile of atazanavir in patients with cardiovascular disease or the high genetic barrier of darunavir or tipranavir in heavily pretreated individuals with HIV.