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Re:Exspectations
Aug 14, 2001

In your response to an earlier question on this topic you said you felt that with new treatments you felt were coming that life exspectancy would be exstended for decades with HIV? What treatments do you feel will result in this occuring and how soon do you expect them to be available?

Response from Dr. Boyle

Well, some of them may already be here. If some regimens are taken religously and there is excellent viral suppression (to less than 50 copies/mL), they may last for years and perhaps a decade or more. For example, the Merck 035 trial which used Crixivan (indinavir), Retrovir (zidovudine, AZT) and Epivir (lamivudine, 3TC) is out five years and using intent-to-treat (missing=failure) analysis 60% of the patients are still less than 500 copies/mL. The DPC 006 trial which in one arm used Sustiva/Stocrin (efavirenz), Retrovir and Epivir is out 3 years and using the very strict intent-to-treat (noncompleter=failure) analysis, 52% of the patients in that arm are less than 50 copies/mL (significantly better than the other two arms of that trial). The Abbott 720 trial, which used Kaletra (lopinavir/ritonavir), Zerit (stavudine) and Epivir, is also out three years and using intent-to-treat (missing=failure) analysis, 76% of the patients are less than 50 copies/mL. These regimens may last for years longer and using a mathematical model, the median time for virologic failure (the time for 1/2 of the patients to fail) of the Sustiva/Stocrin, Retrovir and Epivir regimen in the DPC 006 trial is calculated to be 10 years (One decade!). So, if the current regimens are taken religiously and excellent viral replication is achieved and maintained, these regimens may last a very, very long time. In addition, there are many drugs in the pipeline (e.g., Atazanavir, Tenofovir, Tipranavir, DPC 083, DPC 681/684, T-20, T-1249, Merck integrase inhibitors, etc.) with unique resistance profiles or mechanisms of action, some of which (e.g. tenofovir) should start to be approved in the coming months. In addition, antiretrovirals are becoming simpler to take (there are now several potential once-a-day regimens), with fewer side effects and toxicities. So, I am extremely optimistic regarding the outlook for my patients, especially the ones that take their medications exactly as directed and otherwise take good care of themselves. Good luck to you!



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