December 12, 2003

One combination of AIDS drugs appears better for starting treatment

One specific combination of anti-HIV drugs appears to be more effective for initiating therapy than other combinations tested in a large multi-institutional study. In two reports in the Dec. 11 New England Journal of Medicine, teams led by researchers from the MGH, Stanford University Medical Center and Harvard School of Public Health report that, while all combinations studied were effective in keeping the virus under control, patients who started therapy with a combination of zidovudine (ZDV, also known as AZT), lamivudine (3TC) and efavirenz (EFV) were successfully treated for a longer period of time.

"We've been fortunate to have a variety of choices for antiretroviral therapy," says Gregory Robbins, MD, MPH, of the MGH Infectious Disease Division, who led the MGH research effort. "But many had previously believed that how the drugs were combined did not make much difference. This study shows that some combinations are more powerful than others and that how they are sequenced makes a difference."

One portion of the study, led by Robbins, compared four three-drug regimens to determine whether the order in which they were used affected how long they were successful. The second part, led by Stanford researchers, asked whether using four drugs in combination would be better than two consecutive three-drug regimens. More than 900 patients at sites across the United States and Italy were enrolled, and the overall findings were that the ZDV/3TC/EFV combination was better than the tested three-drug and four-drug combinations in postponing either the first or second drug regimen failure.

The researchers hope to investigate the biological mechanism behind their findings, seeking ways to improve treatment plans and develop options that will be even more successful. Martin Hirsch, MD, director of MGH Clinical AIDS Research, was senior author of the MGH portion of the study.