Comes in capsules containing 200 mg lopinavir and 50 mg ritonavir. Recommended dose is four Kaletra capsules a day.

Evaluation: Protease inhibitors are the heavyweights of HIV meds, and Kaletra is the undisputed champion of the heavyweight division. Kaletra is the foundation of the protease inhibitor-based regimens listed as “preferred” in the current DHHS guidelines. It is generally considered to be the current “standard of care”—the benchmark that all other HIV drugs are measured against. In clinical trials, Kaletra performed well both as initial therapy and as a “salvage” therapy—meaning it worked well for patients who had developed resistance to other HIV drugs. Kaletra has also proved to be an extremely durable drug—it works for a long time. Kaletra is the most-prescribed drug in the protease inhibitor class.

Standard dose of Reyataz is two 200-mg capsules taken with food once-a-day.

Evaluation: Reyataz was approved by the FDA in 2003. It is an “azapeptide” protease inhibitor. The dosing — just two capsules taken with food once-a-day — is very convenient. Reyataz doesn’t seem to raise your cholesterol and triglyceride levels the way most other protease inhibitors do. In fact, one study suggests that Reyataz may actually increase your HDL (good) cholesterol, which helps protect you from heart disease. And it is effective. In a head-to-head comparison with Viracept (nelfinavir), Reyataz was clearly better.

The standard dose of Lexiva is two 700-mg pills twice a day; two 700 mg tablets with two 100 mg capsules of Norvir once daily; or one 700 mg tablet with one 100 mg capsule of Norvir twice daily. You can take it with or without food.

Evaluation: Lexiva was approved by the FDA in 2003. It is a “prodrug” of Agenerase (amprenavir), a protease inhibitor that has been on the market since 1999. Basically, Lexiva turns into Agenerase in your body. The big advantage is in the dosing. The standard dose of Agenerase was 16 huge pills a day, which was just too many. Lexiva’s dosing is far more convenient and it causes fewer side effects. Because Lexiva is so much better, the manufacturer has taken Agenerase off the market.

Comes in 100 mg capsules and 600 mg/7.5 mL oral solution. Recommended dose is 600 mg (6 capsules) every 12 hours. Taking Norvir with food increases its levels in your blood and may make it easier to tolerate. Capsules should be refrigerated, but the oral solution should not.

Evaluation: Although Norvir is still approved for use as a protease inhibitor, hardly anybody uses it that way anymore — twelve pills a day is just too much, it’s hard to tolerate and it interacts with a lot of other drugs.

However, Norvir still has a use! Low doses of Norvir (usually one 100 mg capsule twice a day — sometimes more), when taken with other protease inhibitors boosts the levels of those other PIs in your blood and keeps them active in your blood longer. In some cases, you may be able to lower the amount of the “main” protease inhibitor you’re taking when you take Norvir with it. Prescribing Norvir for its “boosting” effect with other protease inhibitors has become standard practice.

The standard dose of Viracept is five 250 mg pills twice a day or two 625 mg pills twice a day. Food increases the levels of Viracept in your blood, so take it with a meal or a snack. It can be stored at room temperature.

Evaluation: A new formulation of Viracept was approved by the FDA last year that reduces the dose to only two 625 mg pills twice a day, compared to the original dose of five 250mg pills twice a day—a big improvement.

However, Viracept is not a very popular drug. It is infamous for causing diarhea, and it is not as strong, effective or long-lasting as some of the other drugs in the protease inhibitor class.

Comes in 200, 333, and 400 mg. capsules. Recommended dose is 800 mg. (two 400 mg capsules) every 8 hours. Crixivan should be taken on an empty stomach or with a light meal. It can be stored at room temperature.

Evaluation: Crixivan is an old drug that is rarely used anymore. The standard dose of every-eight-hours on an empty stomach is very awkward. Doctors can prescribe Crixivan along with a small dose Norvir. The Norvir boosts the levels of Crixivan in your blood and makes it possible to take it twice a day instead of every eight hours. It also eliminates the need to take Crixivan on an empty stomach. One of the side effects of Crixivan is kidney stones, which are nothing to laugh at. The manufacturer recommends drinking at least six glasses of water every day to reduce the risk of kidney stones, but people get them anyway. Crixivan is not a popular drug.

The standard dose of Aptivaus is 500 mg (two 250 mg capsules) twice-a-day, plus 200 mg twice daily of Norvir. It should be taken with food.

Aptivus is the newest drug on this list. It was approved by the FDA in June, 2005. It is recommended as a "salvage" therapy for people who have tried and failed other HIV regimens. It is always used with a Norvir booster. It seems to work best wehn comgined with Fuzeon. It is not recommended for patients who are new to HIV treatment or using a protease inhibitor for the first time. Because of the risk of liver damage, your doctor should give you a liver function test before starting Aprivus and periodically during treatment.

Comes in 200 mg soft gel capsules. Recommended dose is 1,200 mg (6 capsules) three times a day. Today, Fortovase is almost always prescribed with low-dose Norvir. When taken with Norvir, the standard doze is five 200 mg capsules with one 100 mg capsule of Norvir, taken twice a day. Food increases the level of the drug in your bloodstream six times, so Fortovase should be taken with a large meal. You should refrigerate it, but it can be stored at room temperature for up to 3 months.

Evaluation: Not too many people can take Fortovase, unless it is combined with Norvir to reduce the dose. 18 capsules a day is way, way too many—and it tears up your stomach. Even with Norvir, you’ll still be taking 12 pills a day — plus at least one more to complete your three-drug cocktail. Fortovase is rarely used.

Invirase is the hard gel version of Fortovase. The standard dose is 1,000 mg (two 500 mg capsules) twice daily, combined with 100 mg of Norvir twice daily. Should be taken with food.

Evaluation: Invirase is a little easier on your stomach than Fortovase, but it is still no prize. The manufacturer recently introduced a 500 mg tablet, which reduced the pill burden from five capsules to two 500 mg tablets plus one 100 mg capsule of Norvir taken together twice a day. Invirase is rarely used.

Agenerase has been taken off the market for adults - it has been replaced by Lexiva. It is still available for pediatric use.

Copyright 2006, Positive Health Publications, Inc.

This information is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!