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Study Shows Promise For Simplified Treatment of HIV Infection

A preliminary study indicates that using a single boosted protease inhibitor instead of the standard regimen of 3 drugs for maintenance therapy may be an effective treatment// for select patients with HIV infection, according to a study in the August 16 issue of JAMA, a theme issue on HIV/AIDS.

Susan Swindells, M.B.B.S., of the University of Nebraska Medical Center, Omaha, presented the findings of the study today at a JAMA media briefing at the International AIDS Conference in Toronto.

The long-term adverse effects, expense, and difficulty of sustained adherence to multidrug antiretroviral regimens have prompted studies of simpler therapies for human immunodeficiency virus type 1 (HIV-1) infection. Treatment cessation, intermittent therapy, and induction-maintenance (a few months of triple therapy followed by simplified therapy) regimens have been evaluated with mostly inferior results, according to background information in the article.

Dr. Swindells and colleagues conducted a study to determine whether a simplified maintenance therapy with the antiretroviral medication “boosted” atazanavir alone after virologic suppression (cessation of detectable HIV virus replication) would not markedly increase the risk of virologic failure. Protease inhibitors, such as atazanavir, are often combined with a small dose of ritonavir to increase blood levels – a phenomenon known as “boosting.” This regimen was selected because of low pill burden, once-daily dosing, safety, and unique resistance profile. The 24-week pilot study, conducted between Sept. 2004 and April 2006, included 36 HIV-infected adults with virologic suppression for 48 weeks or longer receiving their first protease inhibitor (PI)–based regimen. Participants switched PIs to atazanavir-ritonavir at entry and discontinued nucleoside analog reverse transcriptase inhibitors (NRTIs) after 6 weeks. Virologic failure was defined as two consecutive HIV-1 RNA measurements of 200 copies/
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