AIDS Treatment Update, Issue 61-62, January-February 1998

- concurrent quadruple therapy with AZT, 3TC, ddC and the NNRTI drug, loviride

- concurrent dual therapy with AZT plus 3TC

- cyclical quadruple therapy, using each of the four drugs on its own for eight weeks and switching to the next in a continuous cycle

The trial compared the effects of the different arms on recipients' viral load and CD4 counts.

Both the concurrent dual and quadruple arms had initial viral load reductions of about 2 logs (over 99% reduction), but this was not as well sustained in the dual combination arm as in the quadruple combination arm. By 64 weeks viral load was on average only 0.5 log below its baseline value in the dual combination arm, compared with 1 log below baseline in the quadruple combination arm.

Although the initial viral load reduction in the cyclical four-drug arm was less than in both the other arms, by 64 weeks it was similar to the dual combination arm, at about 0.5 log below baseline.

Similarly, increases in CD4 count were greatest in the quadruple combination arm. By 64 weeks there was still an average 90 cell increase in this arm, compared with only 20 to 30 cell increases in both the other two arms.

In summary, the results show that while the initial virological effects of concurrent dual and quadruple therapy were similar, the effects were better sustained in the quadruple arm. In the cyclical arm, the initial viral load decline was less initially, but by 64 weeks was similar to the dual concurrent arm.

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