Most effective initial therapy for HIV-1 infection identified
Results published in New England Journal of Medicine identify best drug
combination for patients starting therapy for the first time.
In the largest study of its kind to evaluate commonly
used HIV drugs, researchers at the University of Pittsburgh School of Medicine
confirmed that one of the most frequently prescribed triple-drug combinations
for initial HIV infection is, indeed, the most effective at suppressing HIV. The
study team also found that a two-drug regimen performed comparably to the
triple-drug regimens.
Published in the May 15 issue of New England Journal of Medicine, the study
looked at one of the first class of HIV drugs approved by the U.S. Food and Drug
Administration called nucleoside reverse transcriptase inhibitors (NRTIs) and a
two-drug regimen that did not include NRTIs. Although effective and commonly
prescribed, NRTIs can produce severe side effects in some patients.
The study, which included 753 participants at 55 centers, found that the
popular three-drug combination of efavirenz plus NRTI therapy was more effective
at achieving and maintaining reduction of the virus than another commonly
prescribed drug combination of lopinavir-ritonavir plus NRTI. Interestingly, a
two-drug combination of lopinavir-ritonavir plus efavirenz had a similar level
of effectiveness as each of the triple-drug regimens that contained NRTIs. HIV
levels in 24 percent of the participants in the efavirenz group returned to
detectable levels during the almost two-year study compared to 33 percent of
participants in the lopinavir-ritonavir group and 27 percent of those in the
NRTI-sparing group. All three treatment regimens produced substantial
improvements in immune responses.
“Although all three regimens were well-tolerated and effective, our results
showed that efavirenz with NRTIs should still be considered the gold standard
regimen for initial HIV treatment,” said Sharon Riddler, M.D., M.P.H., lead
author of the study and associate professor of medicine in the division of
infectious diseases at the University of Pittsburgh School of Medicine. “The
results from the NRTI-sparing regimen have given us valuable reassurance that we
can utilize a two-drug therapy regimen based on lopinavir-ritonavir plus
efavirenz for patients who are unable to take NRTI due to side effects.”
“This study not only establishes the best initial therapy for HIV
infection, it opens the way toward simpler regimens that contain fewer drugs,”
said John Mellors, M.D., senior co-author and professor, University of
Pittsburgh School of Medicine and University of Pittsburgh Graduate School of
Public Health.
More information:
 Contact: Clare Collins
CollCX@upmc.edu
412-647-3555
University of Pittsburgh Schools of the Health Sciences
The study was conducted as part of the AIDS Clinical Trials Group with
funding from the National Institute of Allergy and Infectious Diseases.
|
