The Body Covers: The 5th Conference on Retroviruses and Opportunistic Infections
Session 50, Abstract 377: d4T+3TC versus AZT+3TC
February 3, 1998
Shattering the synergy storyA number of trials showed that the combination of d4T+3TC is at least as effective as AZT+3TC, suggesting that d4T may be more attractive than AZT as part of a combination therapy regimen for many patients. Foudraine and colleagues reported on an open-label randomized 24-week trial originally designed to compare the efficacy of two dual-nucleoside regimens: d4T (stavudine, or Zerit) + 3TC (lamuvidine, or Epivir) versus AZT+3TC. Forty-seven treatment-naïve patients were randomized, 45 began treatment, and 39 had completed 24 weeks of study by the time of the presentation (19 patients on the d4T arm, 20 patients on the AZT arm).
For those patients whose viral load was over 500 copies per ml at week 8 of the study, the protease inhibitor indinavir (Crixivan) was added. At week 12, any patient who wished to add indinavir was allowed to do so. By week 24, 95% of those taking AZT+3TC had added indinavir, while 84% of the d4T+3TC arm had done so.
After 24 weeks, 100% of patients on the d4T+3TC+indinavir arm had viral loads below detection (One important point: all patients became 3TC-resistant quickly before starting indinavir, suggesting that in the absence of at least two other drugs (preferably including a protease inhibitor), 3TC's effect is limited in duration.
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