Paper II
2024 August (Supplementary) (2010 Scheme)

Question

Ritonavir in low doses in various Anti retroviral regimes

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Answer

Ritonavir is a potent inhibitor of CYP3A4, the enzyme responsible for metabolizing most other protease inhibitors. At low, sub-therapeutic (“boosting”) doses, ritonavir is added not for its own antiretroviral effect but specifically to inhibit the metabolism of a co-administered protease inhibitor (e.g. lopinavir, atazanavir), raising its plasma concentration and half-life. This pharmacokinetic “boosting” allows lower doses and less frequent dosing of the primary protease inhibitor while maintaining effective plasma levels, improving both efficacy and adherence.

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