First-Line Triple-Combination Antiretroviral Therapy Provides Long-Term Protection Against AIDS

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First-linetriple-combination antiretroviral therapy provides long-term protection againstAIDS-related illnesses, according to a study published Friday in the Lancet,AFP/Google.com reports. The three first-line classes ofantiretrovirals are nucleoside reverse transcriptase inhibitors, non-nucleosidereverse transcriptase inhibitors and protease inhibitors.

For the study, Andrew Phillips of the Royal Free andUniversity College Medical School and colleagues followed 7,916 HIV-positive people living in the United Kingdomwho began standard triple-combination therapy. The researchers found that 167of the participants developed extensive resistance to all three types of drugsand that the resistance was higher among those who began treatment when theirCD4+ T cell counts were lower than 200 (AFP/Google.com, 12/7).

The cumulative risk of extensive triple-combination resistance at the end of 10years was 9.2%, but the risk decreased over time, the study found. The risk ofdeath after five years of developing drug resistance is about 10.6%, accordingto the study (Phillips et al., Lancet, 12/7). Of the participantswho developed drug resistance, 90% were resistant to seven first-lineantiretrovirals. Fifty-eight percent of those who were resistant to first-linedrugs also were resistant to second-line drugs, the study found(AFP/Google.com, 12/7).

The researchers noted that the study's findings will have implications indeveloping countries, where "additional drugs outside these classes areunlikely to be available for some time" (Lancet, 12/7). Accordingto the World Health Organization, more than two million peopleworldwide were receiving standard triple-combination therapy at the end of 2006-- a 54% increase compared with 2005.

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Related Commentary


The findingthat 58% of those who developed resistance to first-line drugs also developedresistance to second-line drugs "has implications for the treatment ofpatients in developing countries," Edward Mills -- of the British Columbia Centre for Excellence inHIV/AIDS -- andJean Nachega -- of Johns Hopkins University -- write in a commentary thataccompanies the study. Mills and Nachega add that in developing countries,"only one or two regimens are normally available, which results indisastrous consequences when these regimes fail."

Mills and Nachega noted that the study participants typically began treatmentearlier, when their immune systems had a greater capacity to fight HIV,compared with people living in developing countries (AFP/Google.com, 12/7).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report ispublished for kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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