Triple therapy based on protease inhibitor best for previously treated HIV patients
Patients with HIV treated previously with nucleoside reverse transcriptase inhibitors (NRTIs) fare better on a triple antiretroviral regimen based on a protease inhibitor than on some other regimens, a study has shown.
European researchers reviewed data from 14 trials to compare the clinical
efficacy of triple therapy that was made up of two NRTIs and either a
protease inhibitor or a non-nucleoside analogue reverse transcriptase
inhibitor (NNRTI) with two drug regimens.
The trials involved 6,785 patients and showed that, overall, triple therapy
was more effective than dual therapy. However, when the researchers looked
at the different types of triple regimens they found that those based
on protease inhibitors showed a larger treatment effect than those based
on NNRTIs (P<0.0001). “Indirect comparisons indicated that the
risk of clinical progression was reduced by 40–50 per cent with
protease inhibitor based regimens,” they say.
The researchers note that it is not possible to extrapolate the results
to patients who have never used antiretroviral drugs. Patients who have
previously undergone prolonged therapy with NRTIs could be resistant
to all drugs in the NRTI class. “In this situation, a regimen containing
one protease inhibitor and two NRTIs could be more effective than a regimen
based on one NNRTI and two NRTIs because the genetic barrier to resistance
is greater with protease inhibitors,” they conclude (BMJ 2004;328:249). |
The
Pharmaceutical Journal