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Nelfinavir,
Efavirenz, or Both After the Failure of Nucleoside Treatment of
HIV Infection [Albrecht MA et al. NEJM 2001;345:398]
This report is from ACTG 364, a randomized, multicenter study of
195 patients who failed treatment with nucleosides with viral loads
exceeding 500 c/mL. Participants were randomized to receive two
nucleosides, including one new one, combined with either nelfinavir,
efavirenz, or both. For combination therapy, standard doses were
used. Results at 40-48 weeks are summarized in the table below,
which shows a superior outcome for the group that received quadruple
therapy, although the difference was significant only for the comparison
of combination therapy vs. nelfinavir.
|
|
NFV
n = 65 |
EFV
n = 62 |
NFV
+ EFV
n = 61 |
| Results
at wk 40-48 |
|
NL< 500 |
35% |
60% |
74% |
|
VL< 50 |
22% |
44% |
64% |
Comment:
This is an interesting and potentially important study because
it utilizes a rescue regimen that has not been extensively studied.
The study showed that efavirenz was superior to nelfinavir in this
group of patients with nucleoside exposure, but no exposure to prior
PIs or NNRTIs. The b.i.d. nelfinavir regimen was used and adherence
was not monitored, so this could have contributed to the difference.
posted
8/17/2001
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