Less Is More When It Comes To The AIDS Cocktail
June 25, 2007
By: Shelagh McNally for Body1
The fight against HIV/AIDS has been mixed. At the end of 2005, Bristol-Myers Squibb announced it had received approval for a 300-mg capsule for Reyataz, one of the drugs in the combination therapy. The new formulation replaced the twice daily dose of 150-mg. The good news follows disappointing results from a recently completed three-year study on AIDS cocktail therapy.| Take Action | What is the AIDS cocktail?
It is known as highly active antiretroviral therapy (HAART)
It consists of three drugs belonging to different families: Efavirenez, sold under the brand name Sustiva, is a Non Nucleoside Analog Reverse Transcriptase Inhibitor. Combivir is a combination of two drugs: Retrovir (300mg) and Epivir (150mg), both of which are Protease Inhibitors.
The cocktail works by strengthening the immune system while reducing the amount of virus in the system and preventing further multiplication of the HIV virus.
Reduces the viral load (also known as the amount of HIV in the blood).
As the viral load goes down, the person's immune system becomes stronger and he or she begins to feel less tired and more energetic.
Not everyone responds to the cocktail therapy in the same way. |
It’s been over 10 years since the therapy was hailed as a minor miracle for its ability to save those infected from certain death. Few breakthroughs have occurred since then, but many researchers had faith that adding a fourth drug to the cocktail would increase its potency. When researchers initially discovered that two drugs work better than one and three worked better than two, the logical assumption was a fourth drug would be even better. To investigate the possibility, the National Institutes of Health, in conjunction with the AIDS Clinical Trials Group (ACTG) initiative began a three-year study to follow 765 HIV/AIDS patients taking the fourth drug.
The results of the study were released simultaneously last year in the Journal of the American Medical Association and at the 16th International AIDS Conference held in Toronto, Canada from August 13 to 18. Unfortunately the news was disappointing.
“We saw no differences over three years between the four and three-drug regimens in terms of decreasing HIV levels, increasing the immune system T cells or side effects,” commented Dr. Roy M. Gulick, director of the HIV Clinical Trials Unit at NewYork-Presbyterian/Weill Cornell and associate professor of medicine at Weill Cornell Medical College. “These findings suggest that current triple-drug therapies continue to perform remarkably well for the large majority of patients. In fact, more than 80 percent of our patients reduced their HIV levels to below detection for the three years of the study. For these patients, adding a fourth drug provided no added benefit.”
The number of patients who saw their HIV levels dip to undetectable was also similar, regardless of whether they took three or four drugs. Eighty-five percent of patients taking zidovudine-lamivudine-efavirenz achieved HIV-1 RNA counts at or below 50 copies per milliliter, compared to 88 percent of those who added in the fourth drug, abacavir. This study suggests that for most patients starting HIV treatment, the standard triple-drug regimens is sufficient to help keep AIDS at bay.
“As long as patients are able to take their medications as directed and see their doctor if and when problems emerge, HIV can be suppressed and the immune system strengthened with the three-drug regimen we routinely use today,” said Gulick.
Despite the standstill, some AIDS patient advocates view the findings as welcome news. Adding a fourth drug would have raised costs in an already overburdened system where there are waiting lists for uninsured patients who need help paying for their HIV drugs. “Keeping treatment regimens as simple as possible is also good news for people living with HIV/AIDS, as adherence is better with easier and smaller regimens,” said Murray Penner of the National Alliance of State and Territorial AIDS Directors. The annual cost per person for antiretroviral drug therapy in 2001 was about $11,000 a year, according to a previous study.
Last updated: 25-Jun-07
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