We now have 14 approved antiretrovirals—that’s 300-plus possible three-drug combos to browse—but zip conclusive data on how best to use ’em. Which regimen to start with? What to do if it fails? Which drugs to add or subtract, and when? Let’s hope these questions of treatment strategy start getting answers once the Treatment Data Project (TDP) website is pulsating with a million HIVer profiles. Until then, POZ promises to do our best to keep you ahead of the data curve. Here are four new tunes, so start humming:
Protease-Sparing Regimen: Just what it says. An antiretroviral combo that doesn’t include a protease inhibitor, usually two nucleoside analogs (most likely AZT/3TC, d4T/ddI or d4T/3TC) and one NNRTI (nonnucleoside reverse-transcriptase inhibitor) such as nevirapine (Viramune), delavirdine (Rescriptor) or efavirenz (Sustiva). Initially, sparing protease was a strategy for those in whom the drugs caused too-severe side effects or failed altogether. Now, as protease-related toxicities increase, more HIVers are adopting this as their first therapy.
Salvage Therapy: A last-ditch option when all standard therapies have failed. For those like our own Stephen Gendin whose supervirus has burned through virtually all combinations, this strategy may include still-unapproved therapies or a regimen of six, seven or more antiretrovirals, known as…
Kitchen-Sink Therapy: A little bit of everything when nothing else is working. These multidrug regimens often include two nukes, two proteases, an NNRTI plus the cancer-med-turned- anti-HIV-drug, hydroxyurea, and perhaps a nucleotide analog (adefovir/Preveon). Their current catch phrase is “CPR for HAART failure”—Complex Protective Regimen for Highly Active AntiRetroviral Therapy failure.
Induction Therapy and Maintenance Therapy: Originally used in cancer chemotherapy, this strategy is based on first mounting a heavy, multidrug assault that destroys most of the virus, and then following up with a sustained regimen of fewer drugs (and fewer toxicities and side effects) that can keep it suppressed. Alas, trials so far show this doesn’t work with current HIV drugs.