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Reducing Meds?
Aug 27, 2003

Any news pointing to the thought of using LESS meds once HIV is undetectable? Thoughts?

Response from Dr. Pierone

Yes, this concept is called induction-maintenance. It is a promising area, studies have been done, and it continues to attract considerable research interest. There is a certain logic to the notion that once the virus has been beaten down, you might not need as intensive a regimen to keep it under control. The induction-maintenance model has also been used successfully in cancer treatment strategies.

Very early on, after protease inhibitors became available, a study was done in which patients that had undetectable viral loads on AZT (zidovudine, Retrovir), 3TC (lamivudine, Epivir), and indinavir (Crixivan) were randomly assigned to either continue triple therapy, take indinavir alone, or take AZT and 3TC. Very quickly it was noted that both the indinavir monotherapy arm and dual nucleoside (AZT, 3TC) were more likely to fail and the study was halted. Several other studies were done around the same time showed similar results and thus triple therapy for HIV infection became standard of care.

However, the antireteroviral medications available today are much more potent, especially the boosted protease inhibitors such as Kaletra. We also have a better understanding of resistance issues and the drug levels in the blood that are needed for viral suppression. As a result a number of studies are underway and some pilot studies have been reported.

There was a very interesting report presented at the IAS conference in Paris that utilized this induction maintenance strategy. In this study link , treatment-nave patients received Crixivan boosted with low dose ritonavir (Norvir) and 2 nucleosides. After the viral load became undetectable, the nucleosides were stopped and patients were just continued on boosted Crixivan alone. These 11 patients were then followed for one year and did not show any signs of viral breakthrough. Large-scale studies of this concept are planned in Europe. There may be similar data (but with Kaletra) presented at the upcoming ICAAC meeting next month in Chicago. There is also a large study well underway that started people on 4 HIV meds and after one year they were randomly assigned to either continue 4 meds, or reduce to 3 meds.

See what you get for asking a simple question? Say tuned, and look out for the ICAAC reporting, maybe there will be more along these lines.



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