The Body Covers: The 5th Conference on Retroviruses and Opportunistic Infections
Session 84, Abstract 664: Therapy with d4T plus 3TC Produces Sustained Undetectable Levels of Plasma HIV RNA in Patients Treated with Reverse Transcriptase (RT) Inhibitors for 10 Years
February 4, 1998
In this small but long-term study, Balfour and colleagues at the University of Minnesota followed a cohort of 9 asymptomatic subjects since their enrollment into ACTG 019 in 1987. These subjects had data collected frequently for 10 years, during which time they sequentially received AZT monotherapy (mean duration of 83 months), AZT + ddI (mean period of 12 months), high-dose d4T "pulse therapy" (for a mean duration of 48 weeks), and, most recently, d4T plus 3TC.
Prior to receipt of d4T plus 3TC, their mean CD4 count was 601 cells/mm3 and their mean viral load was 15,450 copies/ml. The researchers found that 5 patients had at least one mutation associated with AZT resistance, but none had any ddI or d4T resistance mutations.
In all 9 subjects, CD4 counts rose to a mean level of 699 cells/mm3 after one year of treatment. Concurrently, viral load decreased, with a mean viral load level after 52 weeks of 1,131 copies/ml.
Seven subjects had sustained undetectable viral load (While this study was very small, and looked at nine patients whose early involvement in clinical trials indicates a strong commitment to treatment that may not be present in all patients, it did reach interesting conclusions worthy of further study. The researchers indeed found that certain patients who have received long-term reverse transcriptase inhibitor therapy may still benefit from relatively simple dual-nucleoside regimens. The most important point made by the researchers is also worth repeating: a standardized approach to antiretroviral therapy is not necessarily appropriate for all people with HIV disease.
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