Multiple Drug Rescue Therapy for HIV-Infected Individuals with Prior Virologic Failure to Multiple Regimens [Montaner JSG, et al. AIDS 2001;15:61]: This is an observational study of 106 patients from Vancouver who failed multiple antiretroviral regimens and were treated with 5 to 9 antiretroviral agents. Analysis at approximately one year showed viral load <400 c/mL in 40%, severe laboratory abnormalities in 25%, and side effects sufficiently severe to require discontinuation in 7%. The authors conclude that with heavily pretreated patients with extensive phenotypic resistance at baseline, historical, clinical, and laboratory data may not be sufficient to exclude the possibility of response to a multiple drug regimen.
Comment: The editorial comment about this paper was authored by S. Deeks and J. Martin [AIDS 2001; 15:117], who expressed concern about several aspects of this report of mega-HAART. Their major concerns were the lack of an appropriate control group and their perception that simpler regimens would be better tolerated and could be as effective. Specifically, they noted that 60% of these patients had not received NNRTIs and that careful use of resistance testing might permit selection of a simpler and less toxic regimen. They were also disturbed by the clinical outcome, which showed a failure to increase CD4 cell counts and seven deaths.
posted 3/13/2001

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