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Triple nucleoside therapy
Sep 16, 1999

What is your view on the use of triple nucleoside treatments? I tested positive two months ago and want to start treatment now for the possible benefits. I have been advised to start with AZT,3TC and Abacavir. Is this OK or do I need to have a protease inhibitor in there? Thank you

Response from Dr. Cohen

There are studies with the triple nuke approach - without a PI - and usually it appears to work quite well. Based on viral load drops and cd4 count increases - many patients have had similar successes as those who took a PI.

The cautions about this approach come mainly for those with a higher viral load at baseline. An earlier study done suggested that those with a viral load over 100,000 may not have as much success with a triple nuke approach as compared to other approaches. The 24 week results on the study that compared the triple nuke to a standard PI combo suggested similar initial success with either approach at high viral loads - but we'll get more follow up on this important issue at a meeting in a few weeks - and so for those with a high initial viral load - it may be reasonable to wait for more info before making a choice.

As to whether you "need" a PI there or not - this is one of those ongoing controversies in the field right now. There are results - whether with triple nuke, two nukes and a nonnuke, or 2 nukes with a PI - that have shown dramatic success in controlling HIV. And at lower viral loads, probably similar success rates of getting there. And similar CD4 increases. But there may be some differences depending on which meds you use to get this success - including differences in side effects as well as in benefits. And as we've addressed many times here, pros and cons to them all.

good luck. CC



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