Protease Inhibitor: Viracept (Nelflinavir)

PROTEASE INHIBITOR:
VIRACEPT (NELFINAVIR)

What are Protease Inhibitors?
P rotease inhibitors are a new type of antiretroviral (a drug that
stops the reproduction of HIV in your body). Protease drugs
work by blocking a part of HIV called protease. With protease
blocked, HIV makes copies of virus that can't infect new cells.
Studies (clinical trials) of protease inhibitors have shown that these
drugs, taken alone or in combination with other antiretroviral
drugs (AZT, ddl, ddC, d4T, 3TC), can lower viral load (the
amount of HIV in your blood) and raise T-cells (CD4 cells). The
greatest effect has been seen in people taking combination therapy.
However, it's important to remember that more studies are needed
to better understand how to use these drugs.
When Should I Start Taking Protease Inhibitors?
N o one knows exactly when is the best time to begin taking
protease inhibitors. Several studies of people who have low Tcells (100 or lower) have found that those who add a protease
inhibitor along to other HIV medicine get about half as sick as
those who do not. Based on these results, if you have: 1) low Tcells, 2) high viral load, 3) symptoms of illness, and/or 4) have had
HIV disease for a long time, you may want to talk with your doctor
about starting a combination that inclues a protease inhibitor.
Doctors have not yet confirmed that taking these drugs early
in HIV disease-when T-cells are high and viral load is lowwill help prolong life or prevent the development of AIDS. In
theory, starting a protease inhibitor when viral load is low will
allow the drug to be more effective.
Can Drug Resistance Occur with
Protease Inhibitors?
Yes. HIV eventually learns to work around the effect of the
drug. This is called drug resistance. Resistance causes the
drug to work less well or not to work at all. Resistant HIV may
not go away, even if you stop taking the drug. Also, developing
HIV that has resistance to one anti-protease drug will often mean
that the HIV is resistant to other such drugs as well. This is
calledcross-resistance.
Some studies show that taking protease inhibitors in
combination with other anti-HIV drugs may greatly reduce the
chance of developing resistance by further controlling the virus.
To avoid or delay the development of drug resistance, make sure
you take the drugs properly. Skipping doses, taking lower than
prescribed doses, not following food guidelines and not taking
the drugs on schedule weakens the drugs' effect. HIV can then
reproduce more. The more HIV reproduces, the better its chance
to develop drug resistance. If you think that you are not able to
follow the treatment routine which you and your doctor have put
together, then you might want to wait until you are better
prepared to take the drugs properly.
Protease Inhibitor Warning:
The Food and Drug Administration (FDA) have issued an alert
tat a very small number of people experience high blood

sugar and diabetes on all the protease inhibitors currently on the
market. Symptoms of diabetes include increased thirst and
hunger, unexplained weight loss, increased urination, fatigue and
dry itchy skin. If you think you are having any of these
symptoms, check in with your doctor immediately.

Viracept (also called nelfinavir):
Dose
Three 250mg capsules taken every eight hours (3 times a
day) with food. Viracept also comes in a powder
formulation for children. Keep in mind that the amount of
medication you take may be altered when you take
combination therapy.
In a clinical study in people who had taken little or no
anti-HIV medication before, Viracept combined with
AZT/3TC was shown to be more effective than AZT/3TC
dual therapy. Trials of Viracept combined with d4T/ddl are
in progress.
Many experts believe that resistance to Viracept is less
likely to keep other protease inhibitors from working.
However, it is too early to say this for sure.
Storage
Keep capsules dry in their bottle at room temperature.
Side Effects
Mild to moderate diarrhea is the major side effect of
Viracept, occurring in 20% to 30% of the people in clinical
studies. The diarrhea (usually described as two to six bowel
movements a day) can be controlled with over-the-counter
drugs such as Imodium A-D or Kaopectate. Some people
have reported the diarrhea lasts anywhere from three weeks
to two months before going away. Others have found the
condition to be permanent. Nausea and flatulence (gas)
occurred less often.

Cost
Viracept sells for about
$6,500.00 a year. Most
Medicaid programs and
private insurers cover it.
The ADAP program in
New York and many
other states also pay for
Viracept. Agouron, the
company that makes
Viracept, runs a patientassistance program that
will supply the drug at
no cost if you meet
certain qualifications. Call
1-888-777-6637 for more
information about patient
assistance.
Availability
Viracept is available for
adults and children at
pharmacies throughout
the U.S.

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For other Fact Sheets or for more information, contact GMHC, Department of Treatment Education and Advocacy, 119 West 24th Street, New York, NY 10011 [phone]