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Date Posted: 18:22:53 07/24/02 Wed
Author: moonotter
Subject: HIV Protease Inhibitor And NNRTI Regimens Comparably Effective

HIV Protease Inhibitor And NNRTI Regimens Comparably Effective


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 11 - Treatment outcomes of patients with HIV infection who receive initial highly active antiretroviral therapy with a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI) are similar, according to the findings of two trials presented this week at the XIV International AIDS Conference.

In the first trial, Dr. J. Mallolas of Hospital Clinic-IDIBAPS, here in Barcelona, and colleagues designed a 2-year trial to compare the outcome of patients with moderate HIV infection who received one of two highly active antiretroviral therapies as first-line treatment.

The antiretroviral-na ve patients were randomly assigned to ddI, d4T and nelfinavir, or ZDV, 3TC and nevirapine. If treatment failure occurred, the patients were switched to the other treatment arm. A total of 136 patients were available for evaluation at 18 months.

At followup, the proportion of patients who reached the study endpoint of treatment failure was similar in both treatment groups. Likewise, the CD4+ cell counts in both groups were similar.

"These data suggest that the strategy of nelfinavir- or nevirapine-based therapy show similar efficacy in HIV-infected patients," Dr. Mallolas concluded.

In the second trial, Dr. Jose R. Arribas, of Hospital La Paz in Madrid, and colleagues conducted a similar trial with patients with very low CD4+ counts (<40 cells/ L) and very high viral loads (>250,000 copies/mL) at baseline.

Ninety-two patients were assigned HAART containing efavirenz and 122 received a protease inhibitor (indinavir or nelfinavir). None of the patients had a history of antiretroviral therapy.

After adjustment , there were no differences in immunologic or virologic outcome between the efavirenz and the protease-inhibitor groups. After approximately 18 months, time to treatment failure was "significantly longer" in the efavirenz group, Dr. Arribas reported.

Several other studies that compared PI- versus NNRTI-containing regimens were presented at the conference this week.

"When these regimens are taken as prescribed--religiously--the potency is relatively equivalent," Dr. Michael Saag of the University of Alabama at Birmingham told Reuters Heath. "You cannot find a huge difference between any triple drug regimen. In my opinion, a lot of this boils down to tolerability."

In his clinic, the "overwhelming" majority of patients who stop their first regimen within 90 days do so because of tolerability problems. "So the regimen fails, but it doesn't fail because of potency, it fails because of tolerability," he said.

"There are of course some situations in which there is high-level viremia where the potency differences start to segregate. But for the average patient, what matters most is how well the drug is tolerated," Dr. Saag continued.

"We're now more attuned to these concepts as we start therapy," Dr. Saag said. "When I sit down and discuss regimens, I'll present options. The patient who buys into the regimen is the one who's going to take it."



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