Protease Inhibitors: Background Information

One of the best information sources on protease inhibitors continues to be the National AIDS Treatment Advocacy Project (NATAP). You can obtain its written report, get the most current information from its Web site, or obtain videotapes of two major community meetings which NATAP has held so far, in New York (January 26) and Los Angeles (April 13).

* To obtain HIV PROTEASE INHIBITOR REPORT (Second Edition-3/96), by Henry E. Chang and Jules Levin, contact NATAP, 72 Orange Street, #3C, Brooklyn, NY 11201, phone 718/624-8541, fax 718/624-8399. Please do not phone or fax late at night.

* If you can use the World Wide Web, you can get additional information at http://www.natap.org/.

* The entire 4-hour Los Angeles symposium is available on videotape -- $35 for individuals, $100 for professionals (doctors, hospitals, corporations, etc.), free or sliding scale for individuals who cannot afford to pay. You can order it from NATAP at the above address.

Los Angeles Meeting

About 700 people -- apparently a record for any AIDS medical meeting in Los Angeles -- filled the Paramount Pictures Theater on a Saturday afternoon, April 13, for "Protease Inhibitors: Current and Future Use," a free educational forum organized by Jules Levin of NATAP, along with over 15 Los Angeles AIDS organizations. The theater was still full three hours after the program started.

Perhaps the most important theme of the Los Angeles meeting was the need to follow medical advice and use these drugs properly. "Drug holidays," arbitrary dose reductions, and other misuse create windows of opportunity which can help the virus become resistant to the drugs. Once resistance develops, it is probably permanent, and one or more of the protease inhibitors will be less valuable to the patient in the future.

Note that some protease inhibitors must be taken on a full stomach, and others on an empty stomach, to be absorbed effectively. Physicians can give instructions on what is and what is not acceptable.

For persons beginning treatment with the Abbott protease inhibitor ritonavir (Norvir(TM)), Abbott is recommending a dosage ramp-up approach, in which slightly lower doses may be used for the first few days. This dose adjustment may help the body adapt to ritonavir by gradually introducing the drug into the blood. It may reduce unpleasant side effects which some (though not all) patients experience, especially during the first two weeks. Abbott does not expect this approach to increase drug resistance.

It is essential to follow medical advice about not combining the Abbott protease inhibitor with many other common drugs. Some of these drugs can cause life-threatening reactions if combined with ritonavir.

There are fewer side effects and drug interaction problems with the other two approved protease inhibitors, indinavir (Crixivan) and saquinavir (Invirase(TM)). But interaction and other safety precautions must be followed with these drugs too.

Meeting Organizers Note

Persons organizing AIDS meetings should note some of the factors which led to the large attendance of the protease inhibitor symposium in Los Angeles, a city where people are unlikely to come to AIDS meetings. (1) The topic was urgently important, as many people are starting these drugs and need information. (2) The symposium had very good support from local AIDS organizations, some of which mailed the flyer to their clients. (3) Volunteers carried flyers to HIV medical practices and clinics, coffeehouses and bookstores, and other appropriate locations. (4) Meeting organizer Jules Levin came to Los Angeles several days in advance to work full time on the arrangements.