Evidence map›Paper›PMID 40952650›Full record

ArticleInfectious diseases and therapy2025

The Role of Protease Inhibitors in HIV Treatment: Who Still Needs Them in 2025?

Abiu Sempere, Rodrigo Alonso, Leire Berrocal, Julia Calvo, Alberto Foncillas, Iván Chivite, Lorena de la Mora, Alexy Inciarte, Berta Torres, María Martínez-Rebollar and 8 more

Abstract read
In one paragraph

Article in Infectious diseases and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Abiu Sempere *Infectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Rodrigo Alonso *Infectious Disease Service, Hospital de Mataró, Mataró, Spain.
Leire BerrocalInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Julia CalvoInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Alberto FoncillasInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Iván ChiviteInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Lorena de la MoraInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Alexy InciarteInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Berta TorresInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
María Martínez-RebollarInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Montserrat LagunoInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Ana González-CordónInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
José Luis BlancoInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Esteban MartínezInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
José M MiróInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Elisa de LazzariInfectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Josep Mallolas *Infectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain.
Juan Ambrosioni *Infectious Disease Service, HIV Unit, Hospital Clínic Barcelona-Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), 08036, Barcelona, Spain. ambrosioni@clinic.cat.ORCID http://orcid.org/0000-0003-0048-5506

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionProtease inhibitors (PIs) remain an effective antiretroviral therapy (ART) option for people with human immunodeficiency virus (HIV) (PWH), particularly in complex clinical and virological scenarios. However, they are associated with greater metabolic toxicity and drug-drug interactions (DDI) compared with newer ART classes. This study aimed to characterize PWH currently receiving PI-based ART and to explore the reasons for maintaining these regimens.

methodsWe conducted a cross-sectional, observational study of all PWH on PI-based ART as of 30 June 2024 at the HIV Unit of Hospital Clínic de Barcelona. Demographic, clinical, laboratory, ART history, and genotypic resistance data were extracted from the institutional database and compared with the rest of the cohort.

resultsAmong 6261 PWH on ART, 724 (11.6%) were receiving a regimen including a PI; their use progressively declined over the last two decades (p < 0.001). The most frequent reasons for PI prescription were prior virological failure (36%) and toxicity to previous ART (41%). Compared with other PWH, those on PIs were older (median 54 versus 48 years, p < 0.001), more frequently female patients (19% versus 13%, p < 0.001), and had higher rates of heterosexual (33% versus 21%, p < 0.001) and injection-drug-use transmission (15% versus 7%, p < 0.001). Virological suppression was significantly lower among PWH on PIs (88% versus 96%, p < 0.001). Genotypic resistance testing prior to PI prescription was available for 435 PWH; 74% had at least one major resistance substitution, and 70.4% had substitutions affecting two or more antiretroviral classes. In total, 299 PWH had experienced either virological failure or toxicity to non-nucleoside reverse transcriptase inhibitor (NNRTI)- or integrase strand transfer inhibitor (InSTI)-based regimens prior to initiating a PI-based regimen. Among them, 42 had documented failure of or toxicity to both drug classes.

conclusionsAlthough their use has declined, a substantial number of PWH remain on regimens including a PI. These PWH typically have long-standing infections, prior ART failures, and documented resistance substitutions, supporting the continued use of PIs when other therapeutic options are limited.

Indexed as

Antiretroviral therapyDrug resistanceHIVProtease inhibitorsReal-world cohortTreatment-experienced patientsVirological suppression

Identifiers

PMID40952650
PMCPMC12511501

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.