"Maintenance Antiretroviral Therapies in HIV-Infected Subjects
With Undetectable Plasma HIV RNA After Triple-Drug Therapy"
New England Journal of Medicine (10/29/98) Vol. 339, No. 18, P.
1261; Havlir, Diane V.; Marschner, Ian C.; Hirsch, Martin S.;
et al.
Researchers for the AIDS Clinical Trials Group Study 343 Team
report that triple-drug therapy with indinavir, lamivudine, and
zidovudine better sustains the suppression of plasma HIV RNA in
HIV-positive patients than maintenance therapy with indinavir
alone or a combination of zidovudine and lamivudine. The
researchers, led by Dr. Diane V. Havlir of the University of
California at San Diego, investigated less intensive maintenance
programs among patients who had CD4 cell counts of less than 200
per cubic millimeter following triple-drug therapy. The patients
were divided into three groups: 106 continued triple-drug
therapy, 103 received monotherapy with indinavir, and 107
subjects received zidovudine and lamivudine. Only 4 percent of
patients maintaining triple-drug therapy lost viral suppression
(defined as a plasma level of at least 200 copies of HIV RNA per
millimeter on two consecutive measurements during therapy), with
23 percent of monotherapy subjects and 23 percent of dual-therapy
patients showing loss of viral suppression. Those at higher risk
for loss of viral suppression had greater increases in CD4 cell
counts during induction therapy, higher viral loads at baseline,
and slower rates of viral clearance. The authors also note that
zidovudine-resistance mutations in HIV RNA at baseline were
strongly predictive of viral suppression loss in patients
receiving the dual therapy of zidovudine and lamivudine.
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