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Medicineworld.org: Simplified Treatment Of HIV Infection

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Simplified Treatment Of HIV Infection

Simplified Treatment Of HIV Infection
A preliminary study indicates that using a single boosted protease inhibitor instead of the standard regimen of 3 drugs for maintenance treatment may be an effective therapy for select patients with HIV infection, as per a research studyin the August 16 issue of JAMA, a theme issue on HIV/AIDS.

Susan Swindells, M.B.B.S., of the University of Nebraska Medical Center, Omaha, presented the findings of the study today at a JAMA media briefing at the International AIDS Conference in Toronto.

The long-term adverse effects, expense, and difficulty of sustained adherence to multidrug antiretroviral regimens have prompted studies of simpler therapies for human immunodeficiency virus type 1 (HIV-1) infection. Treatment cessation, intermittent treatment, and induction-maintenance (a few months of triple treatment followed by simplified treatment) regimens have been reviewed with mostly inferior results, as per background information in the article.

Dr. Swindells and his colleagues conducted a study to determine whether a simplified maintenance treatment with the antiretroviral medicine "boosted" atazanavir alone after virologic suppression (cessation of detectable HIV virus replication) would not markedly increase the risk of virologic failure. Protease inhibitors, such as atazanavir, are often combined with a small dose of ritonavir to increase blood levels a phenomenon known as "boosting." This regimen was selected because of low pill burden, once-daily dosing, safety, and unique resistance profile. The 24-week pilot study, conducted between Sept. 2004 and April 2006, included 36 HIV-infected adults with virologic suppression for 48 weeks or longer receiving their first protease inhibitor (PI)based regimen. Participants switched PIs to atazanavir-ritonavir at entry and discontinued nucleoside analog reverse transcriptase inhibitors (NRTIs) after 6 weeks. Virologic failure was defined as two consecutive HIV-1 RNA measurements of 200 copies/mL or more. The final analysis included 34 patients.

Virologic success (absence of failure) through 24 weeks of simplified treatment occurred in 91 percent of patients (31 of 34). Three participants experienced virologic failure at 12, 14, and 20 weeks after simplification. Resistance testing at failure did not identify protease inhibitor resistance mutations. Atazanavir concentrations in the blood at failure were low or below detection in 2 of 3 participants experiencing failure, indicating these patients may not have taken the prescribed doses. There were no therapy discontinuations for adverse events after simplification and no significant changes in CD4 cell counts.

"In this pilot study, the data suggest that simplified maintenance treatment with atazanavir-ritonavir alone in patients who have never experienced therapy failure may be efficacious in maintaining HIV-1 RNA suppression below 200 copies/mL for 24 weeks after discontinuing NRTIs," the authors write. "Maintenance treatment with a single boosted PI offers a therapy strategy with potentially less complexity, pill burden, long-term complications, and cost".

The scientists add that eventhough the findings are encouraging, caution regarding inferences is warranted due to study limitations such as the small number of participants in the study. "Larger, randomized trials comparing this approach with standard antiretroviral treatment are warranted".

(JAMA. 2006;296:806-814. Available pre-embargo to the media at www.jamamedia.org).



Posted by: Mark    Source




Did you know?
A preliminary study indicates that using a single boosted protease inhibitor instead of the standard regimen of 3 drugs for maintenance treatment may be an effective therapy for select patients with HIV infection, as per a research studyin the August 16 issue of JAMA, a theme issue on HIV/AIDS.

Medicineworld.org: Simplified Treatment Of HIV Infection

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