There is still debate about whether to initiate protease inhibitors as part of the first treatment regimen offered to a patient or to wait until after the initiation of the antiretrovirals and the start of disease progression, although most experts now recommend triple therapy from the start. In addition, there has been discussion about initiating these medications during the acute infection period and not waiting until several years later, when the virus eventually “outsmarts” the immune system and starts attacking it. Some experts are recommending an aggressive approach, with a combination of antiretrovirals and protease inhibitors given during the primary infection period and continuing for six months. Whether this approach becomes the standard of care for treatment will depend on its long-term effectiveness. Research is continuing in an effort to answer this question.
If a person experiences toxicity or intolerable side effects from the foregoing medication regimens, then an alternative regimen can be chosen. Unfortunately, many people experience side effects from these medications, and changes in medication or dose reductions are often needed.