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Adding New Drugs Keeps HIV Down

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After 48 weeks of treatment, those who took the four-drug cocktail had much lower levels of HIV in their blood. The four drugs worked and kept on working for 77% of the patients. Interestingly, just adding Sustiva to the old drug regimen worked longer than adding only Viracept.

"Even in patients who have been maintained for a long time on dual or triple nucleoside therapy, [treatment] can be enhanced by addition of two new classes of drug," Albrecht says.

The study raises many questions. In the U.S. and Europe, almost nobody starts treatment with just nucs any more. If two new classes of drug are needed for effective salvage therapy, what should a patient start with? Is it better to use an all-out approach at first to keep the virus in check? Or is it better to use only two classes at first and save the other two for later? And will new drugs really be there when they are needed?

Mellors says that the answers to these questions rely more on the art than on the science of medicine.

"When the patient is relatively stable and there is no-near term risk of AIDS or death, then we can wait until we have several drugs available -- each from a new class -- to put in a multidrug combination," Mellors says.

But it's usually not that simple. "We are often facing uncertain prognosis and unknown availability. What to do varies from doctor to doctor," says Mellors. "My personal style is to wait until we can get two or three new drugs."

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