Studies end hopes of reducing complex regimen of AIDS drugs

BMJ 1998; 317 doi: (Published 07 November 1998) Cite this as: BMJ 1998;317:1274
  1. Scott Gottlieb
  1. New York

    Two experimental attempts to cut down on the number of drugs that people infected with HIV are required to take to keep the virus at bay failed when the virus bounced back quickly in many patients.

    The studies have undercut scientists' hopes that people infected with HIV could avoid the need to take a lifelong regimen of drug cocktails, which frequently comprise 20 to 30 pills a day taken according to a precise schedule. The regimen can cost as much as $15000 (£9375) a year and causes a variety of side effects, including vomiting and diarrhoea.

    Previously, scientists speculated that the drug cocktails might reduce HIV infection to such a low level that some of the drugs could be stopped and the virus kept in check by the body's immune system working in concert with a less intensive maintenance regimen or drugs. In two separate studies, researchers set out to see what would happen if they cut back on patients' treatment once the drugs had reduced the virus to almost undetectable levels. Doctors in France and the United States took different approaches but got results so disappointing that both studies were ended early (N Engl J Med 1998;339:1261-76).

    In the United States, virus levels shot up rapidly in 23% of the 107 patients whose treatment was cut back to just two of the drugs–zidovudine and lamivudine–as opposed to the traditional triple drug therapy with indinavir, lamivudine, and zidovudine.

    In the study at France's Pasteur Institute Hospital, which involved 279 patients, 31% of the patients on the two drug combination of zidovudine and lamivudine and 22% of those on zidovudine and indinavir showed signs of viral rebound.

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