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Are 3 drugs really needed to treat HIV???
Aug 20, 2005

Hi Doctors and many thanxs for all your dedicated work. Now then here I am on a tropical island in asia about to start treatment for the first time , options are limited and be it a double edged sword Drs with experience are limited also . My Doc is recomending 'Kaletra' and d4t ( yep the Abbotts rep made a visit ). That's ok but isn't he one drug short ? Counting Kaletra as 2 is not kosher ?? This regime requires another drug such as 3tc or azt does it not ? Please forgive me but treating yourself through the internet is difficult. Once again many thanxs for my main and primary source of assistance , information and comfort. john

Response from Dr. Pierone

Hello and thanks for posting. A standard cocktail for HIV infection contains 3 active agents and this is the approach that virtually all the guidelines recommend. So you are correct that this regimen is one drug short.

However, it will probably work anyway. One of the woefully neglected areas of HIV research involves the study of streamlined therapy. Boosted protease inhibitors are much more potent than the other HIV medications so perhaps a boosted PI-based regimen does not require 3 drugs, maybe 2 will do. Or maybe the boosted PI alone is enough. In fact, there are 5 pilot studies of Kaletra monotherapy that have reported favorable results for treatment of HIV infection (author disclosure: one of these studies was performed by our research team). Maybe 2 agents (or even one) are all that we really need to treat many patients with HIV infection. This sounds like a fairly important question to answer but why the dearth of studies?

Except for Abbott (the maker of Kaletra), there has been absolutely no interest by any of the major HIV pharmaceutical companies to study boosted PI therapy with fewer than 2 nucleosides. GSK (Glaxo-Smith-Kline) could study boosted Lexiva in this manner, but if it worked, it would cut into profits of Combivir, Epzicom, and Trizivir. BMS (Bristol Meyers Squibb) could choose to study boosted Reyataz in this manner, but why compromise their chances to peddle some more Zerit and Videx? Merck could have studied boosted Crixivan (back when this drug was actually used), but choose not to. Before we nominate Abbott for sainthood, remember this is the same company that raised the price of Novir (which the other companies need to boost their PIs) over 400% in one fell swoop last year. What a greedy naked grab for greenbacks. Shame on all of them.

OK, I realize that there is no one in a leadership position in big pharma with the courage to make a decision to support such a study that could cut into profits (even if it was best for other humans suffering with a serious disease).

But what about the academics that are have the ability and authority to do studies of this nature? What sort of torpor are they suffering from? Could it be from excessive consumption of red wine from drug company dinner meetings?

Actually, the AACTG did embark on a pilot study of boosted Reyataz monotherapy (surely to the dismay of BMS) so kudos to this group of intrepid researchers. Stay tuned for new developments in this area.


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