Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. I am doing some research in the AIDS/HIV TA and had a quick
question:
How many people do you think fail first line therapy either do to virologic failure or intolerance of a drug? Also, are there any first-line therapies that you think people fail more so on than others?
If you define success as the percentage of patients maintaining viral loads under 50 at one year, then I would say about 75%. This is based on looking collectively at all the study trials of three drug combinations in treatment-naive patients. Some of the study combinations were in the 60's and some in the 80's. Patients were also counted as failures if they stopped the drugs due to intolerance, not just those with detectable viral loads.
But remember that patients who are enrolled in these studies are seen frequently by the study monitors to get their meds and tests, so compliance may be better than in general patients. Also, some of these studies were done before there was much resistance out there. Now some patients are newly infected with viruses that already have some resistance, so success rates may go down.
Finally, it is interesting to note that when studies involve prison inmates, where every dose is observed every day, slightly over 90% are undetectable at 48 weeks. So we think that a significant part of failure is missed dosages in the general population.
Therefore, regimens which are hardest to take - whether there are too many side-effects or too many pills or too much inconvenience - generally have more failures. But looking at the other side - which regimens seem to have more than 80% success - then I would say a regimen containing efavirenz (Sustiva) is probably is more often found.
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