• The Atlantic Study: a randomized, open-label trial comparing two protease inhibitor (PI)-sparing antiretroviral strategies versus a standard PI-containing regimen, final 48-week data (LBPp7B7046)
  Authored by K. Squires (United States)

The current recommendations for initial antiretroviral therapy suggest use of combinations of antiretroviral agents. There are three classes of antiretroviral agents in current use -- nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). The recommendations suggest use of two NRTIs with either an NNRTI or with one or two PIs. There are limited data comparing NNRTI-based and PI-based regimens. In addition, other strategies, such as combining three NRTIs are also being studied. Effective regimens that are simpler to take and have less toxicity than our current approaches are needed.

Forty-eight week results from a study called the Atlantic study, which compared three different triple antiretroviral regimens, were presented (Squires et al., LBPp7B7046). This study compared the use of regimens containing indinavir (IDV), nevirapine (NVP), or lamivudine (3TC), each given in combination with stavudine (d4T) and didanosine (ddI). NVP and ddI were dosed once per day, and the other medications were given in their usual doses and schedule. Patients and the study team knew which treatments were given. 298 persons with asymptomatic HIV who had not received antiretroviral therapy in the past entered this study. Overall, each of the regimens had a similar effect on HIV viral load. In the patients who entered the study with the highest viral loads, there was a trend toward better suppression of viral load below 50 copies/mL with the IDV regimen. Similar increases in CD4 cells were seen with all three regimens. The toxicities seen followed the patterns expected for these drugs, which have been used in developed countries for several years.

This information provides additional support for use of these regimens in patients starting antiretroviral therapy. It underscores the need for more carefully monitored studies of these regimens in patients with high viral load.