AEGiS-ATDN: What First? Not all treatment combinations are created equal

Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.

What First? Not all treatment combinations are created equal

Information Bulletin #16 - August 2002

Given the limited number of drugs currently available to treat HIV infection, clinicians and researchers have been trying to find out which drugs work best as a first treatment combination. Current US treatment guidelines recommend using two NRTIs (Zerit, Videx, Epivir, Zidovudine, etc.) and one protease inhibitor or protease combination. Another option is using two NRTIs and a non-nucleoside (NNRTI) such as Sustiva.

Apparently, not all drugs are created equal. Several studies presented at the conference indicated a winning combination: AZT, 3TC plus efavirenz (Sustiva). Previous trials have shown that efavirenz is more potent than indinavir (Crixivan) when used as a first line therapy. This time, researchers compared efavirenz (Sustiva), a Non-Nuke, to nelfinavir (Viracept), a Protease Inhibitor, in combination with two different NRTI combinations, AZT + 3TC versus. ddI + d4T, as well as a four drug combination with different NRTIs.

The three-drug combination of AZT, 3TC, and efavirenz was shown to be significantly more potent, with less drug toxicity. These studies were designed before the approval of lopinavir (Kaletra) and tenofovir (Viread). Studies comparing these new drugs are sure to come in the future. An important note of caution is that NNRTIs are known to be easier for HIV to develop resistance to than protease inhibitors. Sustiva also has distinct side effects that might make Viramune (nevirapine) a better choice in certain cases. These issues, and several others, especially your mental health, life-style and ability to actually stick to a regimen should go into deciding a first regimen. Unless you have very low CD4 cells and symptoms of HIV disease, you probably have some time to carefully consider your first regimen, and when you should start it.

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