HIV and AIDS Current Topics in HIV and AIDS

Newer AIDS Treatments Better, But More Expensive

A combination of newer AIDS drugs is simpler to use and more effective than older medications, an international team of researchers has found. Patients who took a one-a-day treatment regimen that made use of a new drug, Viread, were more likely to control the virus compared to those who relied on the old-standby, AZT. The newer combination was also linked to fewer side-effects.

The results, published in The New England Journal of Medicine, fall in the wake of a disappointing government trial that was halted early because an easier treatment approach failed to help. In that study, patients who took periodic breaks from AIDS medications were twice as likely to see their disease progress compared to those who took the drugs continuously, which came as a surprise to National Institutes of Health researchers. Earlier trials suggested that AIDS could be controlled with less stringent medication use.

Still, the latest study comparing Viread to older drugs adds to an encouraging trend in managing AIDS. A decade ago, people with HIV had to take anywhere from 12 to 24 different pills a day, based on a rigorous schedule tied to the timing of meals. Now, patients may only need to take a couple of pills a day, with no food requirements.

"We should get that down to one pill by the end of the year," said Dr. Joel Gallant, an AIDS researcher at Johns Hopkins who led the study. "It's very impressive."

Gallant compared the newer drug combination to what has long been the standard of care in HIV. Half of the 500 patients received a Viread-based combination called Truvada, plus an additional drug, Sustiva. The others received Combivir (AZT plus 3TC), as well as Sustiva. The study was sponsored by the maker of Viread and involved patients who had not previously received anti-retroviral therapy.

Two years later, 80 percent of those who took the one-a-day Viread combo had undetectable levels of HIV, versus 70 percent who were on the twice-a-day AZT one. There were fewer complaints of nausea and fatigue in the group taking the newer combination. In contrast to those who took the older drugs, patients who took the newer treatments also had a higher number of disease-fighting cells.

Patients who are already responding well to the AZT combination should stay the course, Gallant said.

However, after a year of treatment, the researchers started noticing that more patients in the AZT group had significantly less fat on their lower limbs, which can lead to disfiguring changes in body shape over time.

"This is telling me, personally, that something is wrong," Gallant said. "But we still have to see what happens later."

In the meantime, Gallant said that most newly-diagnosed patients are better off with trying the newer combination. The major downside is cost. AZT is now available as a generic, making it far cheaper than the latest AIDS drugs, which can run several thousands of dollars a year. Gallant also warns that Viread has unique side-effects for people who have kidney problems.

But in both effectiveness and ease of use, Gallant said the latest combination appears to be best.

"This has a lot of relevance for people who are just starting therapy," he said.