Treatment of AIDS with combinations of antiretroviral agents

Article Abstract:

Complications encountered in the treatment of AIDS include drug resistance, side effects, and short-term effectiveness (for periods of about one year; often related to drug resistance). These problems contribute to the continued search for effective and safe treatments. (Human immunodeficiency virus, which causes AIDS, is a retrovirus.) A number of effective antiretroviral drugs have been developed: AZT (zidovudine), ddI (2', 3'-dideoxycytidine), ddC (2',3'-dideoxyinosine), and acyclovir. However, to varying degrees, all have been associated with undesirable side effects at the dosage levels or schedules required to treat AIDS. Using an historical perspective, specifically the history of the development of antibiotic therapy, it has now been suggested that a combination of anti-AIDS medications or the sequential administration of various agents may be safer and more effective than the use of an individual drug and long-term treatment. It is recommended that drugs to be used in combination be selected according to specific criteria. First, in laboratory studies, drugs to be considered should not cause the development of similar patterns of resistant strains of the AIDS virus. Second, drugs being considered for combination therapy should act through different mechanisms. Third, they should have different side effects. Sequencing of medications may be an effective strategy as well. In several research protocols, patients are given AZT (a starter regimen) for one year or less, if they develop severe side effects; they are then switched to other drugs or a combination of drugs (called rescues). The shift from starter to rescues usually occurs when the patient begins to show more serious disease, drug complications, or after a lengthy period of time. Results are not yet in, but it is known that more precise indicators of the effectiveness of drug therapy are needed, such as laboratory tests that will help determine when it is time to switch drugs or drug regimens. In this way, the effectiveness of drugs can be maximized, with minimal risk of side effects and undetected complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Retroviruses

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The challenge of combination antiretroviral therapy for AIDS: an introduction

Article Abstract:

Infection with the retrovirus known as human immunodeficiency virus (HIV) is the cause of AIDS. During the past 10 years it has become clear that AIDS can be treated by a variety of methods, and recent research has focused on combining available treatments as a safer and more effective means of controlling HIV infection. A symposium entitled "The Challenge of Combination Antiretroviral Therapy" was held in June 1990 to address this approach. The effectiveness of many of the drugs used to treat HIV has been limited because of severe side effects. These commonly include toxicity to bone marrow, which leads to anemia, and peripheral neuropathy (damage to the nerves in the extremities of the body). Since side effects are usually dose-related, it has been suggested that one way to control for them is to use more than one antiviral drug, each at a nontoxic dosage. Combination drug therapy can also include agents that lessen the side effects of other drugs. In the case of drugs that are toxic to bone marrow, a treatment approach might involve administering growth factors that stimulate bone marrow growth in conjunction with antiviral medication. Because the development of drug-resistant strains of HIV has been a problem as well, it has been suggested that combining drugs may inhibit the development of such strains; this theory is based on similar effects observed in the treatment of other illnesses. Research must continue to develop effective medications to treat HIV infection, and combination therapy be considered as an effective means of controlling side effects and decreasing the likelihood of drug-resistance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Complications and side effects, HIV infection, HIV infections, HIV (Viruses), HIV, Drug resistance in microorganisms, Microbial drug resistance, Virus inactivation, editorial

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