Best AIDS Cocktails for Beginners

Which Drugs to Try First? New Data Guides Crucial Choice

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

July 12, 2002 -- If you have HIV, your life depends on an important choice: which AIDS drugs should you try first? Now you don't have to rely on those glossy ads from the drug companies, thanks to reports from this week's International AIDS Conference.

AIDS doctors know that no later treatment will work as well as your first anti-HIV regimen. That means you want to pick the most effective drugs with the least worrisome side effects and the most convenient dosing. But with 17 different formulations to pick from, it's hard for you -- and your doctor -- to know what to do.

Clever new studies now offer enormous help. They show that particular drugs appear to be especially powerful and durable. In his presentation to the AIDS conference -- available by webcast at the official conference website -- Harvard's Daniel R. Kuritzkes, MD, summed up the findings.

When someone is diagnosed with HIV, they are started on multiple medications in order to hit the virus hard. The best initial regimen should include at least Sustiva or Kaletra (along with Norvir), Kuritzkes says.

In an exciting, late-breaking report on the last day of the AIDS conference, Harvard's Gregory Robbins, MD, MPH, and Stanford's Robert Shafer, MD, reported data from an NIH-sponsored trial. It showed that regimens containing Sustiva worked better than those containing Viramune. When compared with several different drug combinations, drug cocktails containing Sustiva continued to come up on top.

So, a person who has never before taken HIV drugs is probably better off beginning with Sustiva combined with two other powerful drugs.

One factor that has a huge influence on starting regimens is whether a person is infected by an HIV strain that's already resistant to some anti-HIV drugs. An editorial in the July 10 issue of The Journal of the American Medical Association -- by Joel D. Trachtenberg, MD, and Merle A. Sande, MD of the University of Utah -- warns that drug resistance to drugs such as Sustiva is increasing. That may mean that some people will get less benefit from Sustiva than others. Findings such as these make it important to test a patient's HIV for resistance before starting treatment.

The effectiveness of a treatment plan is the most important factor. But even the most effective drugs won't work if patients don't take them every single day of their lives, exactly as directed.

"Patient acceptance is key to long-term adherence," Kuritzkes warns. "Mild [side effects] may lead to lack of compliance and treatment failure."

There are good options other than Sustiva. Norvir combined with either Kaletra or Agenerase would be a good first-choice to combine with two other drugs. Another good choice is to use Ziagen/Epivir or Viread/Epivir plus another potent drug. These may appeal to different people based on different treatment goals, use of other medications, and other individual factors.

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