Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

COMBINATION THERAPIES IN PRIMARY HIV INFECTION

Workman, Cassy*; Downie, J**; Smith, DE***; Sutherland, D****; Michelmore, H**, Dyer W*, Shen, J*; Sullivan, J*


Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. OP1.1
AIDS 1996, Vol. 10 (Suppl. 2);S9

Recent studies suggest that thc viral burden reached at thc resolution of primary infection may determine disease outcome. In an attempt to decrease the viral burden to below detection (BD=<200 copies/ml), combination antiretmviral therapy was instituted in a series of 5 patients undergoing primary infection.

Patients were identified at two primary care centres in Sydney. Diagnosis of primary HIV infection was made on the basis of either a) seroconversion symptoms plus p24 antigenaemia and negative test in last six months (patient 2, 3, and 5); orb) classic seroconversion illness within previous month and positive test with previous negative test in last year (patient 4); or c) known risk exposure within the previous 6 weeks and positive test with negative test within previous 4 months (patient 1). Patients presenting in 1995 were treated with combination nucleosides; saquinavir was added for patients presenting in 1996. RNA PCR (Amplicor), Western Blot (WB) and lymphocyte subsets were performed prior to and during treatment.

Patients 1 and 2 were initiated on AZT (750mg) + 3TC (300mg) while Patients 3, 4 and 5 were initiated on AZT (500mg) + 3TC (600mg) + saquinavir (7200mg). Patient 2's therapy was changed after 7 months to include saquinavir on the basis of deteriorating CD4 counts, correlated with rising viral load.

Treatment was well tolerated with no drug-related discontinuation. No patient has progressed clinically. Duration of treatment is currently 9.5, 9, 5, 1.5 and 0.5 months respectively. Pre-treatment viral loads were 8.4 × 10⁴, 4.7 × 10⁴, 3.2 × 10⁶, 2.5 × 10⁴ and 1.0 × 10⁴ copies/ml respectively. Viral loads in all patients receiving saquinavir, including the patient initiated on nucleoside therapy alone, decreased to and remains BD. Although viral load also decreased in patients on nucleoside therapy alone, none fell to BD and sustained this while on this therapy. Time to first BD reading for Patients 3, 4 and 5 are 15, 3.5 and 2 weeks respectively. Time to first BD reading for Patient 2 post-initiation of saquinavir was 3 weeks.

Aggressive antiviral therapy during primary HIV infection causes a pronounced reduction in viral load. Although combination nucleoside therapy was also effective, the addition of a PI was necessary for viral load to be sustained BD. The tolerability of saquinavir makes the combination of AZT/3TC/saquinavir an attractive regimen for treatment of primary HIV infection. It remains to be determined if this reduction in viral load is sustainable and results in an improved disease free period.

Presenting author: Workman, Cassy

1996-11-03
OP1.1

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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