Correct me if I'm wrong, but boosted PIs have an extremely high resistance barrier, definitely higher than any NNRTI or II.
I do not understand what you mean—boosting in this context is altering the pharmacokinetics of a PI to enable qD rather than BID dosing. How does this enhance the barrier to resistance?
More importantly, I do not agree that the "third agent paradigm" is here to stay indefinitely.
What is your definition of indefinitely? I expect the last enforceable US patent on Truvada to run out in Jan 2018 (#msg-34894135), and I think it’s unlikely the SoC in early lines of HIV treatment will move away from a Truvada backbone before then.
Truvada may be the cleanest nuke but there are cleaner classes now, so I wouldn't be surprised to see nuke-sparing regimens come to dominate first line at some point because of improved tolerability.
I could be wrong but I don’t see this happening before 2018. Regards, Dew
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