Medicine
By Alice Thomas-Tisdale
TORONTO -- Using a once-a-day protease inhibitor appears to work as well with some patients as with those using standard three-drug cocktails to control their HIV infection, said University of Nebraska Medical Center researcher Dr. Susan Swindells. She presented her findings during a media briefing at the International AIDS Conference in Toronto, kicking off the Aug. 16 edition of “The Journal of the American Medical Association.” Swindells' findings are important because they suggest "maintenance therapy with ritonavir-boosted atazanavir alone is a possible option because of low pill burden, once-daily dosing, safety, and unique resistance profile." Most antiretroviral agents must be taken twice-daily. Several, notably ZDV and the protease inhibitors saquinavir and indinavir, must be taken three times a day. A standard dose can range from one tablet twice a day (3TC) to three capsules three times a day (saquinavir). The regime is an important consideration because of other studies suggesting that the amount of pills and the frequency with which these must be taken adversely affect a patient's willingness to continue treatment. Antiretroviral regimens help to maintain serum concentrations of the chosen drugs at levels high enough to suppress viral activity to low levels and prevent the development of drug-resistant viral strains. The rule of thumb for Americans diagnosed HIV+ is medications are started when the CD4 count is at or above 350 and the viral load is 100,000 or higher, or the patient has serious symptoms. When the CD4 count is between 200-349, treatment is considered. When the CD4 count is below 200, treatment or antiretroviral therapy is recommended. Of the 36 HIV participants in the study, nine or 25 percent were black. "Matter of fact," said Swindells, "the first patient to sign up was an African-American woman from Omaha, Nebraska." To qualify for the study, participants had to have no prior virologic failure, a CD4 count less than or equal to 250 T-cells and other relevant factors. Swindells explained: "The long-term adverse effects, expense, and difficulty of sustained adherence to multi-drug antiretroviral regimens have prompted studies of simpler therapies for human immunodeficiency virus type 1 (HIV-1) infection." Therapy Regimen What you need to know about the proposed maintenance therapy: What to Start Antiretroviral therapy with such agents as 3TC, ZDV, and the thrice-daily protease inhibitors saquinavir and indinavir When to Start When CD4 count drops below 350 and before it reaches 200 What to Change Change treatment to simplified maintenance therapy with once-daily doses of ritonavir-boosted atazanavir When to Change 24 weeks after sustained virologic suppression has been observed For a complete report, visit www.jama.com.