Triple-drug treatment regimens appear to be superior to less intensive "maintenance" therapies at maintaining HIV suppression, a study supported by the National Institute of Allergy and Infectious Diseases (NIAID) suggests. Among individuals participating in the study, known as AIDS Clinical Trials Group (ACTG) 343, those who switched from three-drug to two- or one-drug treatment regimens were more likely to experience a resurgence in their HIV levels. A report of the study appears in the Oct. 29, 1998 issue of the New England Journal of Medicine. Similar findings from a French research study are reported in the same issue.
"These findings suggest that patients who have responded well to intensive antiretroviral therapy, as evidenced by prolonged suppression of HIV viral load, should continue with their current treatment regimen," says NIAID Director Anthony S. Fauci, M.D. "Recent research describing persistent HIV reservoirs in individuals receiving highly active antiretroviral therapy (HAART) - even after their viral loads have been driven below the level of detection by current assays - points to the same conclusion." He adds, however, that these data do not eliminate the possibility that this may be a successful strategy for some patients.
Begun in early 1997, ACTG 343 is the first large-scale clinical trial to investigate whether one- or two-drug therapies can hold virus production at bay after HIV levels are driven down by intensive therapy. The multicenter study enrolled more than 500 individuals, each of whom had HIV viral loads greater than 1,000 copies of RNA per milliliter (ml) of blood and at least 200 CD4+ T cells per cubic millimeter (mm3) of blood. During the induction, or initial, phase of the study, all individuals received the protease inhibitor indinavir (IDV) in combination with zidovudine (AZT) and lamivudine (3TC).
After six months, more than 300 individuals whose viral loads had been reduced
to 200 or fewer copies of HIV
Contact: John Bowersox
NIH/National Institute of Allergy and Infectious Diseases