Quadruple regimen shows higher rate of viral suppression
in HIV infection
Treatment with nelfinavir plus efavirenz and two nucleoside
analogues, at least one of which has not been used in the patient before,
achieves a higher rate of viral suppression in patients with human immunodeficiency
virus than therapy with nucleoside analogues and nelfinavir or efavirenz
alone, a new study shows.
Dr Mary Albrecht, Harvard Medical School, Boston,
Massachusetts, and colleagues randomly assigned 195 patients who had previously
been treated with nucleoside analogues (nucleoside transcriptase inhibitors)
to receive either nelfinavir, efavirenz or nelfinavir plus efavirenz,
in addition to two nucleoside analogues. Higher rates of viral load suppression
were achieved at weeks 40 and 48 in those treated with quadruple therapy
compared with those given triple therapy with either nelfinavir or efavirenz.
Triple therapy with efavirenz conferred a higher rate of suppression than
triple therapy with nelfinavir at weeks 16, 40 and 48.
The researchers comment that the benefits of using
additional classes of potent agents to suppress viral replication below
the limit of detection and restore the immune response must be weighed
against the potential risks of incurring new or long term toxic effects.
The study is published in The New England Journal of Medicine (2001;
345:398).
In an accompanying editorial, Dr Julio Montaner,
University of British Columbia, Canada, and Dr John Mellors, University
of Pittsburgh School of Medicine, Pennsylvania, comment: “These results
confirm the importance of prescribing, whenever possible, at least two
drugs of new classes for patients who have already received treatment,
so as to increase the likelihood of a sustained virologic response.” (ibid,
p452).
Back to Top
|
