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Being Alive

Delavirdine and Indinavir Hailed As "Salvage Therapy"




 

Being Alive 1997 Nov 5: 6

Adding the recently approved non-nucleoside reverse transcriptase inhibitor delavirdine to the multidrug regimen of HIV-infected patients experiencing "failure" of protease inhibitors can produce a "remarkable" decrease in viral load and significant clinical improvement. The effect is most pronounced, Dr. Paul Bellman said, when the regimen includes the protease inhibitor indinavir.

"This therapy has reproduced the magic of protease inhibitors for some of the patients for whom protease inhibitors have not worked," he said.

Dr. Bellman, of St. Vincent's Hospital, New York, entered 46 of his patients for whom antiretroviral therapy was not working into Pharmacia and Upjohn's expanded access program for delavirdine (Rescriptor). "This represents a group of patients who are extremely treatment experienced," Dr. Bellman said, "including all of the available protease inhibitors." He noticed very early that some of the patients "were getting really extraordinary benefits." During follow-up, there was a rapid decrease in HIV RNA. "But that obscures the fact that actually a fair number of patients have gone to 'undetectable'," Dr. Bellman noted. While some patients responded minimally or not at all, 12 of the 46 patients have maintained viral levels below the detection threshold for 6 to 10 months.

The efficacy of delavirdine in this setting exceeds expectations based on its intrinsic virologic potency, which Dr Bellman attributes to its synergistic effect with indinavir. Notably, nearly all the patients in the group of complete responders had been on indinavir in combination therapy, had initially responded but had lost viral suppression. The addition of delavirdine "increases indinavir levels, particularly trough levels" by inhibiting the p450 enzyme system in the liver that metabolizes indinavir. Hence, drug levels are increased sufficiently to allow any partial resistance to indinavir to be overcome.

"I believe that indinavir and delavirdine in combination therapy is, at this particular point, the best demonstrated salvage therapy for protease-experienced patients who are breaking through virologically," Dr. Bellman stated. "In my mind, it often has a better response than changing indinavir to ritonavir and saquinavir, or any other combination that has been studied," he added.

Reprinted from We The People with HIV/AIDS of the Delaware Valley.



 




Information in this article was accurate in November 5, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.