A three-drug cocktail used by many HIV-infected people has proved clearly superior to other combinations at treating new patients in the biggest head-to-head comparison of anti-HIV medications to date. The combination--which includes Sustiva, 3TC, and AZT--works better and longer, is easier to take, and suppresses the virus more quickly, the study found, offering powerful confirmation of what many AIDS specialists already believed. Another advantage of the Sustiva-3TC-AZT regimen is that it enables doctors to preserve protease inhibitors for later use, said study codirector Gregory K. Robbins, an AIDS specialist at Harvard Medical School and Massachusetts General Hospital.
The combination, the most commonly prescribed anti-HIV drug cocktail in the United States, is one of three preferred initial regimens included in U.S. government HIV treatment guidelines. "I've had fantastic success with this" combination, said Patricia C. Kloser, a professor of public health at the University of Medicine and Dentistry of New Jersey in Newark who specializes in treating HIV-infected women. "Even when resistance shows, people are hesitant to go off it because it's so easy to take: one pill in the morning and two at night, end of story."
The study involved patients at 58 hospitals and clinics in the United States and 23 in Italy. Researchers, led by doctors at Harvard and Stanford universities, tested several three- and four-drug combinations of six HIV medicines. Nearly 1,000 patients were followed an average of 28 months. A drug combination was deemed a failure when the level of virus in a patient's blood rose, the number of CD4 cells dropped, or the drugs caused toxic effects, including damage to the nervous system, liver, pancreas, and gastrointestinal tract. After about 11 months, a failure occurred in 10% of patients on Sustiva-3TC-AZT, versus 30% to 40% of those on other three-drug regimens.
The National Institute of Allergy and Infectious Diseases funded the research, the findings of which were published in two papers in the December 11 edition of the New England Journal of Medicine.