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POZLife: Life from the Infected and Effected point of veiw.

Study: 4-Drug AIDs Cocktail No Advantage

Posted by pozlife on August 14, 2006

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By CARLA K. JOHNSON

CHICAGO – A four-drug cocktail isn’t any
better for treating newly diagnosed HIV infection than the standard
three-drug regimen, according to a study that followed 765 patients for
three years.

The finding is welcome news to patient advocates,
despite the lack of a step forward in treatment. Adding a fourth drug
would have raised costs in an already overburdened system in which some
states report waiting lists of uninsured patients who need help paying
for their HIV drugs.

The annual cost per person for antiretroviral drug therapy in 2001 was about $11,000 a year, according to a previous study.

Murray
Penner of the National Alliance of State and Territorial AIDS Directors
estimated that adding more drugs to already complex regimens could cost
health systems millions of dollars more.

“Keeping treatment
regimens as simple as possible is also good news for people living with
HIV/AIDS as adherence (taking drugs as prescribed) is better with
easier and smaller regimens,” Penner said.

Adding a drug to the
cocktail also could increase side effects and the potential for
dangerous drug interactions, said Jim Pickett of the AIDS Foundation of
Chicago.

The new study clears up a lingering question posed by
the conflicting results of prior studies. Some smaller studies had
found a quicker effect at beating back the virus when more drugs were
added to the cocktail, while others found no added benefit.

“Triple drug therapy has been the standard approach to treatment of
HIV infection for a decade or so, but there’s always been a question
about whether we could do better with more drugs,” said study co-author
Dr. Dan Kuritzkes of Harvard’s Brigham and Women’s Hospital.

“This reaffirms the potency of the current standard of care,” Kuritzkes said.

Researchers
made the two drug cocktails equally easy for patients to take,
delivering both in five pills taken daily. Patients and their doctors
didn’t know which cocktail they were getting.

The study will
appear in Wednesday’s Journal of the American Medical Association and
was released Sunday to coincide with the opening of the 16th
International AIDS Conference.

Researchers found that the
four-drug cocktail, which added the HIV drug abacavir, had no advantage
in reducing the amount of virus in patients’ blood. Compared with
standard therapy, it also didn’t increase levels of CD4 cells that
fight infection.

“Over the entire course of the study, at no point did there seem to be an advantage of the four-drug regimen,” Kuritzkes said.

Supported
by grants from the National Institutes of Health, the research was
conducted at more than 40 U.S. sites. Several pharmaceutical companies
provided drugs. Some of the researchers, including Kuritzkes, reported
financial ties with the makers of HIV drugs.

More than half the patients in the study were black or Hispanic and almost 20 percent were female.

“It was a pretty diverse population that reflects the epidemic today,” Kuritzkes said.

Black
patients who took the drugs as directed did as well as white patients,
but blacks who did not adhere precisely to the drug routine returned to
high virus levels quicker than whites who didn’t take the drugs as
prescribed. The reason for the difference wasn’t clear, Kuritzkes said.

The study appears in a special issue of JAMA devoted to
HIV/AIDS. The issue includes another study conducted in Botswana that
compared breast-feeding and formula feeding for infants of HIV-positive
mothers. Fewer formula-fed infants became infected with HIV, but they
risked death from diarrhea and pneumonia because of a lack of sanitary
water for making the formula. Another study in the issue found
favorable patient outcomes after a rapid expansion of free
antiretroviral therapy programs in Zambia.

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