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PROMISING HIV TREATMENT CHANGES PUBLIC HEALTH APPROACH.

Two multicenter blinded studies, which now appear in print well after their results were released, provide strong support for the efficacy of combination anti-HIV treatment.

The first study randomized more than 1,000 HIV-infected persons with CD4 cell counts below 200 and at least three months' prior treatment with AZT to either a three-drug regimen (AZT, lamivudine [Epivir], and indinavir [Crixivan]) or a two-drug regimen (AZT and lamivudine).

Rates of AIDS-associated complications and death were approximately halved in the three-drug group compared with the two-drug group at a median follow-up of 38 weeks. The three-drug group also had better responses in CD4 count and plasma HIV-RNA levels.

In the second study, which randomized participants to either of the above two treatment arms or to indinavir alone, patients receiving three drugs also sustained better CD4 cell and viral load responses. More than 90 percent of patients in the three-drug group had CD4 cell counts about 200 cells above baseline levels and plasma HIV-RNA levels below the usual limits of detection after a year's treatment.

Comment: These studies helped create the current practice of treating late-stage HIV-infected persons with three-drug combination regimens. An editorialist argues that such persuasive evidence of treatment efficacy mandates that federal HIV case reporting begin, both to treat the infected and to preserve the health of the uninfected.

— A Zuger

Published in Journal Watch General Medicine September 23, 1997

Citation(s):

Hammer SM et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. N Engl J Med 1997 Sep 11 337 725-733.

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• Medline abstract (Free)

Gulick RM et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 1997 Sep 11 337 734-739.

• Original article (Subscription may be required)
• Medline abstract (Free)

Steinbrook R. Battling HIV on many fronts. N Engl J Med 1997 Sep 11 337 779-780.

• Original article (Subscription may be required)
• Medline abstract (Free)