Tuesday September 18, 2001

Some HIV Patients Do Fine with 2-Drug Combo

By Will Boggs, MD

NEW YORK (Reuters Health) - Perhaps one in five HIV-infected patients appear to remain stable on treatment with an older form of antiretroviral therapy, which suggests some could be spared the toxicity of highly active antiretroviral therapy (HAART), the current gold standard of treatment, according to a new report.

Side effects of HAART, a drug cocktail containing at least three drugs of one or two types, can include liver damage, abnormal body fat deposits and diabetes.

The older treatment, known as dual therapy, consists of two nucleoside analogue reverse transcriptase inhibitors (NRTI).

"Despite rapidly updated international recommendations on antiretroviral therapy which do not mention dual therapy as a possible option, this phenomenon still exists, and has to be taken into account,'' Dr. Roberto Manfredi from the University of Bologna in Italy told Reuters Health.

Manfredi and colleagues followed 163 HIV-infected patients for an average of 24 months after they began dual-NRTI treatment. These patients represented about 20% of the HIV patients cared for at Manfredi's hospital.

To monitor HIV patients, doctors check how many copies of the virus they have in their blood, a measure called the viral load, and also monitor the level of immune system components called CD4 cells.

Over the course of the study period, 113 (or 69%) of the patients on dual-NRTI therapy had viral loads that remained below stable levels. Viral loads climbed above stable levels in the remaining 50 patients, but only 32 (19.6%) saw their CD4 cell count fall by more than 20%.

None of these patients developed AIDS or died during the study period, the investigators note.

Their findings, published in the Journal of Antimicrobial Chemotherapy, suggest that patients with viral loads below 10,000 copies per milliliter of blood and at least 300 to 350 CD4+ cells per microliter of blood can be treated effectively with dual NRTI, the authors report. The therapy ``seems to ensure a stable virological, immunological and clinical disease evolution after at least 2 years of follow-up,'' they explain.

Dual NRTI could also be an option for patients who suffer side effects from HAART, Manfredi added.

He challenged clinicians to review their own records to determine how many of their patients were doing well on a two-drug regimen.