Two classes of antiviral drugs, the reverse transcriptase (RT) inhibitors and the protease (PR) inhibitors, have provided the first successful impact on the human immunodeficiency virus type 1 (HIV-1) epidemic. Zidovudine (ZDV), one of a number of inhibitors targeted to the viral RT enzyme, significantly reduces pediatric infection by maternal transmission when administered to infected women during pregnancy and delivery, and to their newborns during the first 6 weeks of life.1 Inhibitors targeted at the HIV-1 PR can suppress plasma virus by greater than 1.5 log,, copies per milliliter below pretreatment levels, and in some cases to levels that are undetectable (<50 RNA copies/ml plasma). Diminished virus burden is accompanied by increases in CD4 T lymphocytes, although the extent of immune cell reconstitution appears to be influenced by factors in addition
MAUREEN M. GOODENOW and JOHN W. SLEASMAN • Department of Pathology, Immunology, and Laboratory Medicine, and Division of Immunology and Infectious Diseases, Department of Pediatrics, College of Medicine, Health Science Center, University of Florida, Gainesville, Florida 32610. ELENA E. PEREZ • Department of Pathology, Immunology, and Laboratory Medicine, and Medical Scientist Training Program, College of Medicine, Health Science Center, University of Florida, Gainesville, Florida 32610.
Human Retroviral Infections, edited by Kenneth E. Ugen et al. Kluwer Academic / Plenum Publishers, New York, 2000.
to virus decline. Five PR inhibitors, namely saquinavir, ritonavir, indinavir, amprenavir, and nelfinavir, are approved by the Food and Drug Adminisua-tion (FDA) for use in combination therapies to treat adult HIV-1 infection. Ritonavir, amprenavir, and nelfinavir are also approved for HIV-1-infected children, while indinavir and saquinavir are in Phase 1/11 studies for pedi-atric patients.
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