Studies reveal the latest findings in HIV treatment
Studies reveal the latest findings in HIV treatment
Researchers share findings at national meeting
The country’s leading HIV researchers gathered in San Francisco recently for the Seventh Annual Conference on Retroviruses and Oppor tunistic Infections. Attendees offered case managers valuable information on achieving better outcomes for their HIV-infected patients.
Three studies presented at the conference found Norvir (ritonavir), a protease inhibitor manufactured by Abbott Laboratories in Abbott Park, IL, effectively reduced HIV to undetectable levels when used in combination with other anti-HIV drugs. (For more information on ritonavir, visit Abbott’s Web site at www.abbott.com.)
1. Ritonavir/saquinavir. The ritonavir and saquinavir combination showed sustained viral suppression after nearly three years in 85%, or 120 of 141, patients achieving undetectable levels of virus at some point during the 144-week study with or without intensification with nucleoside reverse transcriptase inhibitors. Ninety-one patients who started the study remained on therapy after three years, with more than half, or 53 of 91, on ritonavir/saquinavir therapy without nucleoside reverse transcriptase inhibitors.
2. Ritonavir/indinavir. A multisite, open-label study examined the pharmacokinetic and clinical effects of adding ritonavir to indinavir regimens in patients with detectable HIV levels. Patients receiving indinavir three times daily with two nucleoside reverse transcriptase inhibitors were switched to a combination containing ritonavir/ indinavir twice daily. Ritonavir was introduced through dose titration to enhance patient tolerability. Data at three weeks showed that ritonavir improved indinavir pharmacokinetics by increasing indinavir trough levels by 272% and decreasing peak levels by 51%.
In addition, statistically significant improvements in viral load and CD4 cell counts were observed after three weeks of ritonavir/indinavir combination therapy.
3. Ritonavir/nelfinavir. Thirty-four pediatric patients with a median age of 5.8 years received either nelfinavir administered three times daily without ritonavir (n=8) or nelfinavir twice daily with ritonavir (n=26). After four weeks of therapy, the average nelfinavir clearance of the ritonavir/ nelfinavir combination was reduced as compared to patients receiving nelfinavir without ritonavir. In addition, the combination of nelfinavir and ritonavir twice daily produced pre-dose, average, and peak nelfinavir concentrations that were at least as high as those resulting from nelfinavir alone three times daily.
HIV-infected patients who failed exclusive treatment with nucleoside reverse transcriptase inhibit ors and were switched to a triple-class regimen containing nelfinavir mesylate reported significantly greater and more durable reductions in plasma HIV levels at 48 weeks than patients receiving a two-class regimen in a randomized clinical trial.
In the trial, 195 patients were evaluated in a study to compare a regimen combining nelfinavir mesylate with efavirenz plus nucleoside reverse transcriptase inhibitors (Arm A) to a regimen combining nelfinavir mesylate, placebo, and nucleoside reverse transcriptase inhibitors (Arm B) and a regimen combining efavirenz, placebo, and nucleoside reverse transcriptase inhibitors (Arm C). Findings include:
• At 48 weeks, 67% of the triple-class treated patients achieved undetectable plasma HIV levels, compared with 22% in Arm B and 44% in Arm C.
• At week 16, it took significantly longer for patients in Arm A to breach higher plasma HIV levels when experiencing viral rebound than for patients in either Arm B or Arm C.
Nelfinavir mesylate is manufactured by Agouron Pharmaceuticals in La Jolla, CA, under the brand name Viracept. For full prescribing information, fax (888) 288-9639.
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