Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Protease inhibitors as initial therapy for individuals with an intermediate risk of HIV disease progression: is more necessarily better?
AIDS. 1999 Jan 14;13(1):97-102. Unique Identifier : AIDSLINE MED/99223957 Schechter M; Struchiner CJ; Harrison LH; Infectious Diseases Service, Hospital Universitario Clementino; Fraga Filho, Rio de Janeiro, Brazil.
Abstract:
OBJECTIVE: To compare three possible therapeutic strategies for the treatment of patients with an intermediate risk of HIV disease progression. DESIGN: Mathematical modeling based on assumptions derived from published data. METHODS: A parametric survival model was fitted to empirical data to describe the survival trajectory of untreated individuals. It was assumed that successful treatment decreases the risk of disease progression curing the first year after its introduction by a constant that is dependent on the magnitude of the initial drop in HIV viral load. Thereafter, individual members of the treatment cohort follow different pathways, depending on the duration of the initial response or, in case of virologic failure, the response to a new drug regimen. RESULTS: Sub-groups of patients starting therapy with two nucleoside reverse transcriptase inhibitors (NRTI) or two NRTI and a protease inhibitor had the highest instantaneous risk of disease progression at the end of the 5-year follow-up period. Patients who started therapy with two NRTI and a non-NRTI had the lowest likelihood of progression to AIDS or death at 5 years of follow-up. This is because, in the case of the subgroup whose initial treatment included a protease inhibitor, failure rates due to non-adherence to therapy are high and response to salvage therapy is limited by past protease inhibitor experience. CONCLUSIONS: Despite the superior virologic potency of the protease inhibitor-containing regimens, in this analysis other strategies performed equally well or even better. In the absence of solid empirical data and until the advent of antiretroviral regimens that are shown to be safe, simple to take, and maximally suppress viral load, caution may be required in selecting the long-term therapy for patients with less advanced HIV disease.
Keywords: JOURNAL ARTICLE Anti-HIV Agents/*THERAPEUTIC USE Disease Progression Human HIV Infections/*DRUG THERAPY/IMMUNOLOGY/PHYSIOPATHOLOGY/VIROLOGY HIV Protease Inhibitors/*THERAPEUTIC USE *Models, Biological *Models, Statistical Reverse Transcriptase Inhibitors/*THERAPEUTIC USE Risk Factors Support, Non-U.S. Gov't 990930
A9991336
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
