Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.
Resistance to anti-HIV treatment regimens is probably inevitable, so doctors and their patients have to consider future options. Finding a reasonable treatment regimen for people with virus that is resistant to many anti-HIV drugs is not easy. Doctors often call such regimens "salvage" or rescue therapy. In one study, doctors tested the combination of efavirenz, nelfinavir and d4T and obtained promising results in just over 50% of the subjects.
Researchers enrolled 47 subjects who had the following characteristics at the start of the study:
Subjects in the study received the following drugs:
Results-viral load and CD4+ cell counts
Researchers divided the subjects into the following two groups based on the effect of anti-HIV therapy:
Responders maintained significant decreases in viral load (below the 500 copy mark) for 12 months. In fact, about 60% of responding subjects had a viral load below 50 by the 12 th month of the study. At that time, the average CD4+ count was about 311 cells.
Researchers looked at factors that may explain the poor response seen in the non-responder group. The following factors, as assessed at the start of the study, had no effect on the response to therapy:
Factors that did appear to have an impact on the response to therapy were chiefly related to the prior use of anti-HIV drugs. Specifically, non-responders seemed to have been exposed to more of the following drugs than responders:
Technicians also discovered that four non-responders had nelfinavir levels in the blood that were low to provide significant anti-HIV activity.
According to the researchers, there were no unexpected side effects during the study. Some subjects reported side effects that usually appeared during the first two weeks of the study and that were likely caused by efavirenz, including the following:
Two subjects also developed very severe skin rashes, also probably caused by efavirenz. These subjects had to interrupt their therapy until the rashes became less severe.
Since subjects were taking nelfinavir, it is not surprising that diarrhea occurred. Doctors prescribed Imodium (loperamide) and other drugs to help subjects manage this complication. Only three subjects developed the following severe gastrointestinal side effects:
Two subjects co-infected with hepatitis B and C viruses experienced "flare-ups" of these infections during the first four months of therapy. The infections died down once they stopped taking the study regimen.
1. Seminari E, Maggiolo F, Villani P, et al. Efavirenz, nelfinavir and stavudine rescue combination therapy in HIV-1 positive patients heavily pre-treated with nucleoside analogues and protease inhibitors. Journal of Acquired Immune Deficiency Syndromes 1999;22(5):453-460.
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