The Body Covers: The 5th Conference on Retroviruses and Opportunistic Infections
Session 54: Antiretroviral Therapy: Salvage Regimens
February 3, 1998
Poster session abstracts 419 - 428Management of a failing regimen was addressed by numerous investigators. An assortment of approaches was tried, including one in which SIX antiviral drugs were given.
Deeks (poster 419) reported on a large community based cohort and described an apparent discordance between virologic and immunologic/clinical failure. In this group, a significant proportion of patients had "broken through" HAART, as determined by serial viral load measurements. Yet many maintained stable or even improved CD4 cell counts and overall health. Although follow-up in this group of discordant responders was less than a year, the authors suggested that immunologic/clinical failure and virologic failure may not be synonymous, at least in the short term.
A report from Workman (poster 426) described a 6-drug salvage regimen (d4t, ddI, 3TC, nevirapine, nelfinavir, and saquinavir) among 12 patients who had failed "everything." Their median VL was 42,000 at entry copies. In the report, all 9 of the 12 patients who were able to remain on the complicated regimen had undetectable virus at 12 weeks. Longer term follow-up will help establish the relative utility and practicality of this dramatic approach.
Gallant reported (poster 427) on the effectiveness of 2-PI (ritonavir and saquinavir) salvage among 21 patients failing either indinavir (17 patients) or nelfinavir (4 patients). The group had a VL of 13,000, lower than that reported in many other salvage studies. With 7 month follow-up, 12 of 17 indinavir failures and 3 of 4 nelfinavir failures responded to the salvage (VL became undetectable). This relatively high response rate raises the possibility that earlier switches to more potent regimens may be an effective strategy to optimize salvage.
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