"A Randomized Trial of Three Maintenance Regimens Given After
Three Months of Induction Therapy With Zidovudine, Lamivudine,
and Indinavir in Previously Untreated HIV-1-Infected Patients"
New England Journal of Medicine (10/29/98) Vol. 339, No. 18, P.
1269; Pialoux, Gilles; Raffi, Francois; Brun-Vezinet, Francoise;
et al.
Two-drug maintenance therapy following a three-month regimen of
triple-drug therapy for HIV-positive individuals is less
effective than continuation of the triple-drug therapy, according
to French researchers. To determine whether problems related to
compliance and tolerability could be reduced through the
administration of a two-drug regimen rather than a three-drug
regimen, researchers from the Trilege Study Team investigated
maintenance programs on viral suppression in 378 patients. The
patients, who were antiretroviral naive, received three months of
induction treatment with lamivudine, zidovudine, and indinavir.
Of the initial patients, 279 had plasma HIV-1 RNA levels fall
below 500 copies per cubic millimeter after two months. These
patients were then assigned to either continued triple-drug
therapy or two-drug maintenance therapy with zidovudine and
lamivudine or zidovudine and indinavir. The researchers observed
that 31 percent of the patients receiving zidovudine plus
lamivudine and 21 percent of those on zidovudine plus indinavir
had virologic failure. Comparatively, 9 percent of patients who
continued triple-drug therapy experienced virologic failure. The
authors note that among patients who switched to dual-therapy,
even those subjects with maximally suppressed HIV-1 RNA (defined
as less than 50 copies per millimeter) had a higher failure rate.
The scientists concluded that two-drug therapy is less effective
in sustaining a reduced viral load than triple-drug therapy. |
