|lopinavir and ritonavir
Some of these medicines must be used with ritonavir.
How It Works
Protease inhibitors (PIs) are
antiretroviral medicines. They prevent
HIV from multiplying, reducing the amount of virus in
your body. When the amount of virus in the blood is kept at a minimum, the
immune system has a chance to recover and grow
Why It Is Used
The use of three or more
antiretroviral medicines (antiretroviral therapy), or ART) is the usual treatment for HIV infection.
combination of medicines used for ART will depend on your health, other
conditions you might have (such as
hepatitis), and results of testing. Talk to your
doctor about the best treatment plan for you.
Medical experts recommend that people begin treatment for HIV as soon as they know that they are infected.1, 2 Treatment is especially important for pregnant women, people who have other infections (such as tuberculosis or hepatitis), and people who have symptoms of AIDS.
You may also want to start HIV treatment if your sex partner does not have HIV. Treatment of your HIV infection can help prevent the spread of HIV to your sex partner.3
The U.S. National Institutes of Health recommend one of the following programs for people who begin treatment for HIV:3
- HIV: When Should I Start Antiretroviral Medicines for HIV Infection?
HIV: Taking Antiretroviral Medicines
How Well It Works
- Reduces viral loads, which can lead to stable
or increased CD4+ cell counts, a sign that the immune system is still able to
- Decreases the
number and severity of opportunistic infections.
- Reduces or
prevents the occurrence of
resistance to the medicines.
- Prolongs life.
Antiretroviral therapy can also decrease symptoms of HIV
infection, such as fever and weakness, and help the person gain weight.
The rate at which antiretrovirals decrease viral loads is affected
- CD4+ cell counts at the beginning of
- Viral load at the beginning of
- The dosage of the medicines.
- Whether the
medicines are taken exactly as prescribed.
- Whether antiretroviral
medicines have been taken before.
- Whether any
opportunistic infections are present.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911or other emergency services right away if you have:
Call your doctor if you have:
Common side effects of these medicines include:
To prevent serious medicine
interactions or a decrease in medicine effectiveness, be sure to learn
which medicines should not be taken with PIs and other antiretroviral
Indinavir causes kidney stones in a small number of people who use it. The risk of kidney stones can
be reduced by drinking at least
48 fl oz (1.4 L) of fluid each
Some protease inhibitors slightly increase the risk of having a heart attack.4
Side effects of any combination medicine can include the
side effects of any of the single medicines in the combination.
Report all side effects to your doctor at your next visit. He or she can
adjust your dose or give you other medicines to reduce side effects. Some mild
side effects, such as nausea, improve as your body adjusts to the
Many people think antiretroviral
medicines always have severe side effects. In fact, only a few people
experience severe or dangerous side effects.
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
What To Think About
Food increases the
absorption of atazanavir, nelfinavir, and darunavir.5
Certain acid-reducing medicines, such as omeprazole or famotidine, should not
be taken at the same time as atazanavir. Before you take protease inhibitors (PIs), be sure to tell your doctor about any
other medicines you are taking.
Resistance to PIs develops more frequently if these medicines are used
alone or are not taken exactly as prescribed.
Lopinavir is combined with a
low dose of ritonavir to inhibit the breakdown of lopinavir in the body. This
delayed breakdown of lopinavir increases its effectiveness.
PIs are expensive. They can
cost up to two times more than nucleoside/nucleotide reverse transcriptase
Things to think about when choosing a
combination of medicines include:
- The ability of the medicines to reduce your
- The likelihood the virus will develop resistance to a
certain class of medicine. If you have already been treated with a certain
antiretroviral medicine, you may already know whether you are resistant to
medicines in that class.
- Side effects and your willingness to
- The cost of treatment.
Do not use the nonprescription herbal supplement
St. John's wort while you are taking a protease inhibitor, because St. John's
wort can interfere with how well these medicines work.
to your doctor about whether you can eat grapefruit or drink grapefruit juice
while you are taking protease inhibitors. It may increase the side effects of
some of these medicines.6
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
U.S. Department of Health and
Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2012). Guidelines for the Use of Antiretroviral Agents
in HIV-1-Infected Adults and Adolescents. Available online: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.
Thompson MA, et al. (2012). Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society—USA Panel. JAMA, 308(4): 387–402.
U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2011). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Lang S, et al. (2010). Impact of individual antiretroviral drugs
on the risk of myocardial infarction
in human immunodeficiency virus–infected patients. Archives of Internal Medicine, 170(14): 1228–1238.
Atazanavir (Reyataz) and emtricitabine (Emtriva) for HIV infection (2003). Medical Letter on Drugs and Therapeutics, 45(1169): 90-92.
Tatro DS (2004, January). Keeping up: Interactions of herbal supplements and grapefruit juice with medications used to treat HIV infection. Drug Facts and Comparisons News: 3–5.
Primary Medical Reviewer
||E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
||Peter Shalit, MD, PhD - Internal Medicine
||November 7, 2012