Treatment Review No. 23 - December 1996

This study was an example of just adding one new drug to current treatment. Researchers no longer think that this is a good idea, because people in this study seemed to have gotten resistant to the effects of ritonavir after six months. The effects may have been longer lasting if people had changed their other anti-HIV treatments at the same time as starting ritonavir.

In this study in people with less than 100 T4 cells, ritonavir was found to help people live longer, and delay progression of disease. There were 1090 people in this study. The average T4 cell count was around 20. People were allowed to take AZT, ddI, ddC or d4T while on the study. One group of people added ritonavir to the medications they were taking, the second group got a placebo or dummy pill.

After an average of six months, 46 people taking the placebo had died compared to 26 people taking ritonavir. This means that for people taking ritonavir, the risk of death was greatly reduced - almost halved - compared to people taking the placebo. Eighteen percent of the participants on ritonavir discontinued because of side effects.

AZT/ddI

This combination has been shown to improve health and extend life compared to AZT alone in people with less than 500 T4 cells. This effect was seen even if people had already been on AZT for a while. The improvements in health were linked to how well the drugs reduced viral load.

AZT/ddC

This combination has been shown to improve health and extend life compared to AZT alone in people with less than 500 T4 cells. This effect was only seen in people who had never taken any anti-HIV drugs before. The combination of AZT and ddC did not seem to help people who had already been taking AZT. As with AZT and ddI, the improvements in health were linked to how well the drugs reduced viral load.

AZT/3TC

This combination has been shown to greatly reduce viral load. Also, a large European trial of 3TC enrolled 1,892 people with T4 cells between 25 and 250. Participants in this study were already being treated with AZT, or AZT with ddI, or AZT with ddC. People were randomly divided into three groups. One group added 3TC to their current treatment. The second group added 3TC and an experimental drug called loviride. The third group added a placebo. The study was stopped after one year because people receiving 3TC had a 54% reduction in disease progression and death.

d4T/3TC

This is a very popular combination therapy, but it has not been very well studied. Two small studies have shown that this combination can cause a greater than 90% drop in viral load within a few weeks. The long term effects of the combination on viral load are not yet known.

saquinavir/ddC

A recent study compared the combination of saquinavir and ddC (trade name HIVID) to saquinavir or ddC taken alone. The average T4 cell count of people in the study was 160-180. Everyone had taken AZT for over a year before joining the study. This study found that the combination reduced the death rate by two thirds - after a year and a half there had been 28 deaths on ddC, 34 on saquinavir and 9 in the combination saquinavir/ddC group. The current thinking is that taking ddC or saquinavir by themselves is not a good idea, because the anti-HIV effects are so weak.

d4T/ddI

An ongoing study has found that this combination may have strong anti-HIV effects. The viral load in people in this study was reduced by over 99%, and a few people have maintained this reduction for a year. Surprisingly, little peripheral neuropathy occurred in any of the doses tested. This combination has only been studied in people who have never taken anti-HIV drugs before. ddI/hydroxyurea (Hydrea)

Hydroxyurea is a cancer treatment that may help ddI work better. In a year long study in France, people taking the combination have had their viral load reduced by 90% or more. No major side effects have been seen so far. One study has suggested that taking ddI with hydroxyurea may work even if HIV has gotten resistant to the effects of ddI used alone. Two studies of the ddI/hydroxyurea combination have recently begun in the US. Call The Network for a referral.

delavirdine (Rescriptor) and AZT

Delavirdine is an experimental anti-HIV drug in a class known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). It is currently available through expanded access for people with less than 300 T4 cells. The main side effect is a rash. Delavirdine has been shown to reduce viral load in combination with AZT. A study combining delavirdine with AZT and 3TC is ongoing. New information on delavirdine is likely to be available soon.

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