Novel four-drug salvage treatment regimens after failure of a human immunodeficiency virus type 1 protease inhibitor-containing regimen: antiviral activity and correlation of baseline phenotypic drug susceptibility with virologic outcome

J Infect Dis. 1999 Jun;179(6):1375-81. doi: 10.1086/314775.

Abstract

Twenty human immunodeficiency virus-infected patients experiencing virologic failure of an indinavir- or ritonavir-containing treatment regimen were evaluated in a prospective, open-label study. Subjects received nelfinavir, saquinavir, abacavir, and either another nucleoside analog (n=10) or nevirapine (n=10). Patients treated with the nevirapine-containing regimen experienced significantly greater virologic suppression at week 24 than those not treated with nevirapine (P=.04). Baseline phenotypic drug susceptibility was strongly correlated with outcome in both treatment arms. Subjects with baseline virus phenotypically sensitive to 2 or 3 drugs in the salvage regimen experienced significantly greater virus load suppression than those with baseline virus sensitive to 0 or 1 drug (median week-24 change=-2.24 log and -0.35 log, respectively; P=.01). In conclusion, non-nucleoside reverse transcriptase inhibitors may represent a potent drug in salvage therapy regimens after failure of an indinavir or ritonavir regimen. Phenotypic resistance testing may provide a useful tool for selecting more effective salvage regimens.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Dideoxynucleosides / therapeutic use
  • Drug Resistance, Microbial
  • Drug Therapy, Combination
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1 / drug effects*
  • HIV-1 / genetics
  • Humans
  • Indinavir / therapeutic use
  • Male
  • Nelfinavir / therapeutic use
  • Nevirapine / therapeutic use
  • Phenotype
  • Prospective Studies
  • RNA, Viral / blood
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Ritonavir / therapeutic use
  • Salvage Therapy*
  • Saquinavir / therapeutic use

Substances

  • Dideoxynucleosides
  • HIV Protease Inhibitors
  • RNA, Viral
  • Reverse Transcriptase Inhibitors
  • Indinavir
  • Nevirapine
  • Nelfinavir
  • Saquinavir
  • Ritonavir
  • abacavir

Associated data

  • GENBANK/AF124541
  • GENBANK/AF124542
  • GENBANK/AF124543
  • GENBANK/AF124544
  • GENBANK/AF124545
  • GENBANK/AF124546
  • GENBANK/AF124547
  • GENBANK/AF124548
  • GENBANK/AF124549
  • GENBANK/AF124550
  • GENBANK/AF124551
  • GENBANK/AF124552
  • GENBANK/AF124553
  • GENBANK/AF124554
  • GENBANK/AF124555
  • GENBANK/AF124556