Nevirapine: One-Year Combination Results Published
Some triple-drug combinations not including a protease inhibitor have been proposed as "protease sparing" regimens, for certain patients who might want to start with a somewhat easier combination treatment and/or save the protease inhibitors for later. Last week, results of the one-year INCAS study (named for the countries where it was run--Italy, the Netherlands, Canada, and Australia) were formally published.1 One arm of this study, which treated 51 volunteers with AZT plus ddI plus nevirapine, found that viral load was undetectable for one year in about half of those treated. The patients in this study were among the easiest to treat, however--as they were antiretroviral naive, and also had not had any AIDS-defining diagnosis.An accompanying editorial,2 also in the same issue of the Journal of the American Medical Association, concluded, "Currently, for patients with advanced HIV disease or AIDS, effective antiretroviral therapy requires starting treatment with a regimen that includes a protease inhibitor. For patients with earlier stages of HIV disease, the choice among currently available regimens should be carefully considered, with easier-to-take regimens kept in mind. The philosophy of 'treat early, treat hard' in early HIV infection must now yield to a philosophy of 'treat smart' for all stages of HIV infection."
The article and editorial are currently available on the Web,
References
1. Montaner JSG, Reiss P, Cooper D and others. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients. JAMA; March 25, 1998; volume 279, pages 930-937.
2. Gulick, RM. HIV Treatment Strategies. JAMA; March 25, 1998; volume 279, pages 957-958.
