Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
The Associated Press - Thursday, Dec. 16, 1999
Jeff Donn, Associated Press Writer
Over the past few years, drug combinations containing a breakthrough class of medicines called protease inhibitors have made AIDS a treatable disease. Yet some patients fail to benefit, largely because they cannot cope with taking 15 or 20 pills a day on a precise schedule.
Two new studies suggest that Sustiva, one of a new class of AIDS medicines, may actually work better than the standard treatment, perhaps because it requires fewer pills and has fewer side effects.
Sustiva, generically called efavirenz, was approved last year. It is already joining protease inhibitors as one of the first-line treatments for the AIDS virus.
Sustiva is known as a non-nucleoside analogue. Like older AIDS drugs, such as AZT, it blocks a certain enzyme the virus needs to reproduce, but does so in a different way.
Sustiva is taken once a day, while protease inhibitors often must be taken three times daily.
The studies underscoring Sustiva's effectiveness were published in today's New England Journal of Medicine. One was study was conducted in adults, the other in children.
The findings offer "one more drug you can choose from when you sit down with a patient," said Dr. Robert Schooley of the University of Colorado, an AIDS doctor familiar with the research.
In the study of 450 HIV-infected adults, blood levels of the virus fell to undetectable levels in 48 percent of those given the standard regimen of a protease inhibitor plus two older drugs, compared with 70 percent of those taking a mix of Sustiva and the same two other drugs.
Also, 43 percent of the protease inhibitor patients stopped treatment because of side effects. Only 27 percent of the Sustiva group dropped out. HIV drugs can cause nausea, rash, headaches and fatigue, among other things.
"This study really revolutionizes the way HIV is treated," said Dr. Karen Tashima of Brown University, one of the researchers. "It's becoming or has become first-line therapy."
Dr. Nathan Clumeck of Saint-Pierre University Hospital, in Brussels, Belgium, said a variety of drug mixes without protease inhibitors hold much promise because they need to be given less often, interact less with other drugs and can generally be well-tolerated by patients.
"I think that one of the most difficult things is the patient's ability to take what are often very complicated regimes," said Dr. Bruce Walker, who runs the AIDS Research Center at Massachusetts General Hospital.
In the past, protease inhibitors have failed to work in children as well as they work in adults. In the second study in the journal, doctors tested a drug mix with both Sustiva and a protease inhibitor on 57 youngsters who had taken only the older medicines. Youngsters' blood levels of the virus fell to undetectable levels in 63 percent.
"We believe we're simply seeing a more potent combination," said chief researcher Dr. Stuart Starr of Children's Hospital of Philadelphia.
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