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HIV & AIDS Health Center

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Sustiva + Combivir First Choice for HIV

Best First-Line AIDS Treatment Postpones Protease Inhibitors
WebMD Health News

Dec. 11, 2003 -- Now it's official. The best first-line treatment for HIV disease is a three-drug cocktail of Sustiva, Retrovir, and Epivir -- or Sustiva plus Combivir, which combines the other two drugs.

The findings come from a long-awaited study. The results, published in two papers, appear in the Dec. 11 issue of The New England Journal of Medicine.

"Until now, it has been unclear which sequences of antiretroviral regimens provide the greatest benefit to patients previously untreated," Massachusetts General Hospital researcher Gregory K. Robbins, MD, MPH, lead researcher of one of the papers, says in a news release.

Battle of HIV Drug Types

The cleverly designed study evaluated combinations of three different classes of anti-HIV drugs.

The bottom line was to see how long it took each three-drug regimen to fail. The winner, by far, was the Sustiva + Retrovir/Epivir combination. The loser was the Stavudine/Videx combination, which had the highest rate of toxicity. Based on these findings, the Stavudine/Videx combination is no longer recommended as a first-line treatment.

Even so, all the drug regimens worked quite well at keeping patients from progressing to AIDS. But Sustiva/Retrovir/Epivir failed in only 10% of patients. Other three-drug regimens had a 30% to 40% failure rate.

Nelfinavir, the protease inhibitor, was quite effective -- but not as good as Sustiva. That's welcome news. Now the powerful Nelfinavir -- and its sister protease inhibitors -- can be saved for a powerful second attack when first-line treatments fail to keep HIV under control.

More good news is the fact that the Sustiva/Retrovir/Epivir combination means fewer pills -- and fewer food restrictions. That's going to help people stay on the drugs -- which people with HIV infection must do to prevent treatment failure.

Adding a fourth drug to the three-drug Sustiva/Retrovir/Epivir combination -- even Nelfinavir -- had no added effect.

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