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Adding New Drugs Keeps HIV Down

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In this new study, Albrecht, a researcher at Harvard's Beth Israel Deaconess Medical Center, and co-workers studied 195 people with HIV. All of them had been treated only with nucs, such as AZT, Videx, and Hivid. Most had taken at least two of these drugs for a long time. Though they were doing pretty well most had low -- but not dangerously low -- numbers of immune system cells needed to fight HIV, and HIV levels were rising.

For the new HIV cocktail, the researchers gave all the study participants two nucs -- at least one of which was new to them. They also gave them one of three other HIV treatments: the non-nuc Sustiva, the PI Viracept, or a combination of the two.

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.

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