AIDS Treatment Update, Issue 58, October 1997
Edward King

At the International Workshop on HIV Drug Resistance, Treatment Strategies and Eradication in Florida this summer, researchers reported on two people who started treatment with AZT, ddI and nevirapine, then stopped taking the ddI after their viral load fell below 40 copies/ml. Their viral load remained `undetectable' for more than one year in which they took only AZT plus nevirapine. In the same trial, people who started treatment with AZT plus nevirapine, rather than with all three drugs, did not achieve `undetectable' viral load.

In the UK, the ProCom trial (due to start this month) is testing subtractive therapy in which people with CD4 counts below 350 or viral load greater than 20,000 will start therapy with d4T, ddI, saquinavir (in the new Fortovase formulation) and nelfinavir. Participants may be starting anti-HIV therapy for the first time, or may have taken AZT, 3TC or ddC (or loviride in the Quattro trial) before.

Everyone will receive at least four months of four-drug therapy to try to achieve viral load below 400 copies/ml, and a recent change allows this to be extended to five or six months if necessary for people whose viral load remains above 400.

After a maximum of 24 weeks of quadruple therapy, however, all participants must proceed with the randomised stage of the study, or withdraw. The randomisation will allocate one-third to remain on all four drugs, one-third to reduce therapy to just d4T plus ddI, and one-third to reduce to just saquinavir plus nelfinavir. Re-introduction of four drugs and changes to alternative therapy are allowed during follow-up if there is evidence of treatment failure.

Hall D et al. `Induction therapy: proof of concept by withdrawal of didanosine from zidovudine plus nevirapine plus didanosine'. International Workshop on HIV Drug Resistance, Treatment Strategies and Eradication, Florida, abstract 130, 1997.

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