Posts
Boosting the number of antiretrovirals (ARVs) administered to treat acute and early HIV infection is not effective, according to a study presented at this week’s 18th Conference on Retroviruses and Opportunistic Infections in Boston.Forty-eight weeks into the 96-week study, patients receiving five drugs had equivalent amounts of HIV RNA in their blood compared to those receiving standard three-drug therapy, and there also was no difference in a range of other immune system measurements, said Martin Markowitz, MD, of New York’s Aaron Diamond AIDS Research Center. The results suggest that “upping the ante from the get-go may not work,” he said.
Markowitz and colleagues enrolled 40 early-stage HIV patients and randomly assigned them, in a one-to-two fashion, to receive either three or five medications.
In the three-drug arm, 14 patients took a fixed-dose combination of the reverse transcriptase inhibitors tenofovir and emtricitabine (Truvada) and a boosted protease inhibitor - either atazanavir (Reyataz) or darunavir (Prezista).
In the five-drug arm, 26 patients received the same drugs plus the entry inhibitor maraviroc (Selzentry) and the integrase inhibitor raltegravir (Isentress).
“We measured pretty much everything that can be measured, and to make the story rather simple, we did not see any substantial or significant differences,” Markowitz said.
Thirty-four patients remained in the study. Among results at 48 weeks:
*While the five-drug patients achieved undetectable HIV RNA levels more rapidly than the three-drug patients, by 24 weeks there was no significant difference in the proportion with undetectable virus.
*In both study arms, patients had strong recovery of CD4+ cells of about 300 each; there was no significant difference between the groups.
*No differences were found in levels of proviral DNA or cell-associated HIV RNA, or their rates of decay over time.
*No differences were found in levels of naïve and total CD4 cells or immune system activation markers.
*All three patients who had virological failure were in the five-drug group.
*No different responses were found between those who were acutely infected, about one-quarter of patients, and those in the later-early phase.
Scott Hammer, MD, chief of infectious diseases at New York-Presbyterian/Columbia University Medical Center, said the results comport with those of “study after study.” “You can intervene with antiretrovirals, you can drive the [HIV] RNA down, but there’s an irreducible minimum you can’t get below,” Hammer said. Very early on in the course of infection, HIV seems to establish a reservoir that is unaffected by current treatments, he said.
The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
TOGETHER WE REMAIN STRONG!
