HIV Therapy Simplification Cuts Adverse Events

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Reuters Health

Information via Medscape

HIV Therapy

Simplification Cuts Adverse Events

Posted by Al Benson

Switching patients with HIV to a three-drug

antiretroviral regimen after 48 weeks on four-drug therapy can maintain

virological control and immunological response while reducing lipid levels and

adverse events, researchers report in the July 1st issue of the Journal of

Acquired Immunodeficiency Syndromes.

Although a number of studies have investigated a

similar induction-maintenance approach to antiretroviral therapy, Dr.

Markowitz of The Diamond AIDS Research Center, New York and colleagues

assert that this is the first to show success.

The researchers treated 448 antiretroviral-nave

patients with abacavir/lamivudine/zidovudine and efavirenz as initial

antiretroviral therapy for a 48-week induction phase, after which 282 were

randomized to continue with the four-drug regimen or to the three drugs without

efavirenz for another 48 weeks.

By 96 weeks, 79% of patients who continued on

the four drugs and 77% of those on the triple drug regimen had HIV-1 RNA levels

below 50 copies/mL. CD4 T cell counts were 453 cells/mm in the three-drug group

and 425 cells/mm in the quadruple therapy group.

Fifteen percent of patients on the four-drug

regimen reported adverse effects, compared to 6% of those on triple-drug

therapy. During maintenance, 16 of patients on the three drugs had virologic

failure. This was true of 8 on the four-drug regimen. Although this difference

was not statistically significant, Dr. Markowitz and colleagues write, " it

is important to note. "

Total cholesterol, LDL cholesterol and triglycerides

stayed high during maintenance therapy in the four-drug group, but declined

among those patients on triple-drug therapy. Total cholesterol fell 22 mg/dL in

the three-drug group, LDL cholesterol fell by 16.5 mg/dL and triglycerides

dropped by 16 mg/dL.

More patients on the abbreviated drug regimen

reported perfect adherence to therapy, with 88.8% doing so at 96 weeks compared

to 79.6% of those on the quadruple drug regimen.

The researchers conclude that the trial

" should be the impetus to explore induction-maintenance strategies further

in treatment-nave and treatment-experienced patients. "

J Acquir Immune Defic Syndr 2005;39:257-264.