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intermittently shuffled regimen: COULD IT BE EFFECTIVE IN AVOIDING DRUG RESISTANCE?
Oct 13, 2012

hi Dr BY, this is a well known fact that triple drug combination decreases the likelihood of emergence of drug resistance. to make this theory robust, can we design a pulsatile regimen of two different HAART combo at an interval? (for example, to start with 2NRTI+1NNRTI, then even without virological failure with this regimen we start a PI based regimen for 1 year and then again come back to first regimen for 2 years, again PI based for 1 year). I think, statistics of HIV viral dynamics will not allow emergence of any drug resistance as long as VL is kept UD. Is there any peer reviewed paper on such intermittently shuffled regimen? regards, Dr Titas... India.

Response from Dr. Young

Hello Dr. Titas and thanks for posting your idea.

The concept of rotating treatment regimens was address by the AIDS Clinical Trials Group many years ago- and found no particular benefit; mindful that this study was conducted in an era of less potent, and side effect prone medications. (Unfortunately, I can't find the citation of this study). Indeed, my concern about cycling treatment regimens is the potential exposure to multiple drug classes and risk of multi-drug class resistance over time.

Frankly, with today's potent and well tolerated options, it's really rare to see first-line treatment failure among people who are adherent to medications and the real goal is to identify the regimen that is best suited to the individual's health background and life-, diet- and work habits. A larger issue with all strategy trials, is that with such low observed rates of virological failure, it would be very difficult to perform a randomized clinical study of sufficient power to demonstrate the benefit.

Hope that helps, BY



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