AEGiS-13IAC: Outcome of the first triple-drug therapy in the real world situation.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Outcome of the first triple-drug therapy in the real world situation.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrB612)

Lafeuillade A, Jolly P, Lambry V, Philip G, Hittinger G, Chadapaud S
A. Lafeuillade, CHITS, Hopital Chalucet, Rue Chalucet, 83056 Toulon, France, Tel.: +33 4 942 277 41, Fax: +33 4 949 267 47, E-mail: avps@club-internet.fr

BACKGROUND: controled therapeutic trials often show better results than routine practice. To know the real impact of triple-drug therapy in a population of every day practice, we have analysed the outcome of the first triple combination prescribed to 500 consecutive HIV-infected patients.

METHODS: between October 1995 and January 2000, 500 HIV-infected patients received a 3-drug combination in our hospital. We analysed retrospectively the case records and biological results of this series with emphasis on tolerance and outcome. In each case, CD4 lymphocyte counts, plasma HIV-1 RNA levels, and cholesterol/triglyceride levels were available at least every 2 months.

RESULTS: at present we have analysed the first 200 patients. The CDC group at baseline was A in 79 cases, B in 76 and C in 45. Mean CD4+ T cell count at baseline was 315 é 17 cells/m L. Most cases (117 patients) were experienced (mono or bi-therapy) and 83 were naive of prior therapy. This first triple-therapy contained a Protease inhibitor in 114 (57%) cases and 3 RT inhibitors in 86 cases. During this follow-up period of 4 years, 59 percent of cases had a change in their regime, within a mean period of 6 é 3 months after initiation. This change was mainly motivated by intolerance (57%) or inefficacy (38%). Fifty six percent of the patients reached, at least once, undetectable plasma RNA levels (limit of detection: 200 copies/ml). Cholesterol and/or triglyceride levels increased during therapy in 73% of patients receiving a Protease inhibitor vs 13% of patients on triple-RT inhibitors.

CONCLUSION: in current practice, a majority of patients need a change in their initial triple-drug therapy within a few months, mainly related to tolerance problems, acceptability (compliance) and inefficacy. The association of 3 RT inhibitors is widely used, even before the availability of new options like Efavirenz and Abacavir. Such an approach gives less metabolic side effects.

Keywords: AEGIS, CD4 Lymphocyte Count, Anti-HIV Agents, HIV Infections, HIV Protease Inhibitors, Dideoxynucleosides, Antiretroviral Therapy, Highly Active, Drug Therapy, Combination, HIV, Oxazines, HIV Protease, HIV-1 Reverse Transcriptase, abacavir, efavirenz, Human, drug therapy
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WeOrB612