Alternative multidrug regimen provides improved suppression of HIV-1 replication over triple therapy.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Alternative multidrug regimen provides improved suppression of HIV-1 replication over triple therapy.

AIDS. 1998 Jul 30;12(11):F117-22. Unique Identifier : AIDSLINE MED/98372106
Weverling GJ; Lange JM; Jurriaans S; Prins JM; Lukashov VV; Notermans DW; Roos M; Schuitemaker H; Hoetelmans RM; Danner SA; Goudsmit J; de Wolf F; National AIDS Therapy Evaluation Centre, Department of Internal; Medicine, University of Amsterdam, The Netherlands.

Abstract: OBJECTIVE: To compare the viral suppression of two antiretroviral regimens using three drugs or five drugs. DESIGN: Two open-label studies using a three-drug (zidovudine, lamivudine and ritonavir) and a five-drug regimen (zidovudine, lamivudine, abacavir, indinavir and nevirapine) in study-drug-naive patients, except for one in the five-drug study. METHODS: Participants with > or = 10 000 HIV-1 RNA copies/ml in plasma at baseline were compared by means of Kaplan-Meier curves for time to < 50 copies/ml, as well as linear regression analysis for the first phase of decline using log-transformed copy numbers. RESULTS: The elimination rate constants for HIV-1 RNA in 15 participants of the three-drug study were compared with nine participants of the five-drug study. The level of < 50 copies/ml was reached earlier when using the five-drug than when using the three-drug regimen (P log rank = 0.0005): median time to reach this level was 4 weeks and 12 weeks, respectively. No differences were found in HIV-1 RNA elimination rate constants in the first 2 weeks after the initiation of therapy. When the viral load declines were calculated from day 2 onwards, adjusting for differences in pharmacological delay of the drugs used, again no differences in early viral load decline were found between the two regimens. CONCLUSION: With the five drugs used in this study, the median time to reach < 50 HIV-1 RNA copies/ml was 8 weeks shorter than with the three-drug regimen. This finding shows that suppression of viral load in HIV-infection by standard triple-drug therapy can be improved upon.

Keywords: JOURNAL ARTICLE Adult Anti-HIV Agents/*THERAPEUTIC USE Comparative Study Data Interpretation, Statistical Dideoxynucleosides/THERAPEUTIC USE Drug Therapy, Combination Female Human HIV Infections/*DRUG THERAPY/IMMUNOLOGY/*VIROLOGY HIV Protease Inhibitors/*THERAPEUTIC USE *HIV-1/GENETICS/PHYSIOLOGY Indinavir/THERAPEUTIC USE Lamivudine/THERAPEUTIC USE Male Nevirapine/THERAPEUTIC USE Reverse Transcriptase Inhibitors/*THERAPEUTIC USE Ritonavir/THERAPEUTIC USE RNA, Viral/BLOOD Support, Non-U.S. Gov't *Virus Replication Zidovudine/THERAPEUTIC USE
990130
A9911072

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