Saquinavir & ritonavir

Saquinavir & ritonavir

AIDS Treatment Update, No. 44, August 1996
Edward King

The protease inhibitors ritonavir and saquinavir can be used safely in combination, according to the first six weeks' results of an ongoing study. Since the discovery that ritonavir can boost saquinavir levels thirty-five fold in rats, manufacturers of the two drugs have been warning doctors and patients not to combine the two drugs until more is known. Now it is clear that short-term combination use of the two drugs is safe, said Dr Bill Cameron.

Recognised side-effects of ritonavir including tingling around the mouth, diarrhoea, fatigue and nausea were the most common side-effects when people started treatment. After six weeks all adverse reactions had cleared up, and only one person came off treatment due to the side-effects. Ritonavir's side-effects can also be reduced by starting treatment at a lower dose and gradually increasing it.

Saquinavir is currently prescribed at a dose of 600mg three times a day. In this study, two lower doses of saquinavir (400 or 600 mg twice daily) were tested in combination with a standard dose of ritonavir (600 mg twice daily). After six weeks of treatment, 86% had experienced at least a 2 log (99%) reduction in viral load or a fall to below detectable levels (less than 200 copies/ml), and the average increase in CD4 count was 98. All patients had been heavily pre-treated with anti-retrovirals. The two doses of saquinavir seem to be roughly comparable, with a trend for the higher dose to produce greater antiviral effects. More results from this ongoing study are expected in September 1996.

It was also reported that ritonavir lengthens the period of time that other protease inhibitors stay in the blood, opening up the prospect of other protease combinations (Th.B.934).

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