CCO Management Series
Double-Boosted Protease Inhibitors
Double-Boosted Protease Inhibitor Regimens: a Pharmacologic and Pharmacokinetic Perspective
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Module 1 of 3
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CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
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 Topics covered include:
- Introduction
- Pharmacologic Rationale
- Pharmacokinetic Considerations and Issues
- Lopinavir/Ritonavir Double-Boosted PI Combinations
- Lopinavir/Ritonavir Double-Boosted PI Combinations (Continued)
Learning Objectives
Upon completion of this activity, participants should be able to:
Identify specific double-boosting PI regimens that may have clinical utility Understand the underlying mechanisms for the complex drug-drug interactions between coadministered PIs Discuss the concept of pharmacokinetic boosting and the pharmacokinetic effects of ritonavir in a double-boosted protease inhibitor (PI) regimen
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Clinical Data on Double-Boosted Protease Inhibitor Regimens
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Module 2 of 3
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CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
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Topics covered include:
- Introduction
- Rationale
- Choice of Protease Inhibitors
- Clinical Trials
- Saquinavir Plus Lopinavir/Ritonavir
Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss the study designs used in noncomparative clinical trials evaluating double-boosted PI regimens in treatment-naive and -experienced HIV-infected patients Discuss the virologic, immunologic, and safety results from noncomparative clinical trials evaluating double-boosted PI regimens in treatment-naive and -experienced HIV-infected patients Understand the rationale for considering specific protease inhibitors (PIs) as components of a double-boosted PI regimen
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Potential Therapeutic Strategies Using Double-Boosted Protease Inhibitor Regimens
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Module 3 of 3
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CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
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Topics covered include:
- Introduction
- Protease Inhibitor Boosting
- Interactions Between Double-Boosted PIs
- Rationale for NRTI-Sparing Therapy
- Clinical Strategies for NRTI-Sparing Therapy
Learning Objectives
Upon completion of this activity, participants should be able to:
Identify the clinical situations in which a double-boosted protease inhibitor strategy would be appropriate. Understand the rationale for the use of double-boosted protease inhibitors. Discuss the use of double-boosted protease inhibitor regimens as a nucleoside reverse transcriptase inhibitor-sparing treatment approach.
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Interactive Case Challenges
A Treatment-Naive Patient Infected With Multiclass-Resistant HIV
CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
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 Explore options and receive feedback on your choices of antiretroviral therapy in a treatment-naive patient who was initially infected with highly drug-resistant HIV. Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss the clinical management of patients who acquire highly drug-resistant HIV. Review the pharmacologic rationale for the use of double-boosted protease inhibitor regimens. Describe interactions between protease inhibitors and agents that increase gastric pH.
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A Patient with a History of NRTI-Associated Lactic Acidosis
CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
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Consider appropriate clinical management choices for a patient with limited NRTI options, and review our faculty's recommendations. Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss appropriate antiretroviral options for a patient who has recovered from NRTI-associated lactic acidosis. Describe drug-drug interactions between protease inhibitors. Review factors associated with successful therapy with enfuvirtide.
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Salvage Therapy in a Multidrug-Experienced Patient
CME Program Director:
John P. Phair, MD
Program Director:
Jonathan M. Schapiro, MD
 
- Bonaventura Clotet, MD, PhD
- Roger Paredes, MD
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Evaluate the optimal use of antiretroviral agents and laboratory tests in a highly treatment-experienced patient, and compare your choices with those of other readers. Learning Objectives
Upon completion of this activity, participants should be able to:
Review the role of resistance testing in the management of HIV-infected patients with virologic failure. Discuss the optimal use of antiretroviral agents in highly treatment-experienced HIV-infected patients. Describe the benefits and risks of treatment interruptions in HIV-infected patients who require salvage therapy.
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Disclaimer: The materials published on the Clinical Care Options Web site reflect the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the CME provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
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Jointly sponsored by Northwestern University’s Feinberg School of Medicine and Clinical Care Options, LLC.
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Educational grants support only the CME-certified components of this program.
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