According to Project Inform’s Martin Delaney, at presstime the Public Health Service (PHS) was drafting a radical revision of the Standard of Care for HIV treatment. The PHS panel of physicians, activists and officials recommends slugging the virus with as potent a protease/nuke three-drug cocktail as possible. Merck’s Crixivan (indinavir), Abbott’s ritonavir (Norvir) and Viracept (nelfinavir), the new Agouran protease, are first choices; Roche’s saquinavir (Invirase) didn’t make the cut. No guidelines about the preferred nuke duo will be issued (in practice, d4T/3TC is gaining fast on front-runner AZT/3TC), but do expect a warning: Don’t tack a protease onto your current regimen—switch one or both nukes to combat resistance. While backing the “Hit It Hard” half of last year’s mantra, the experts backed off from endorsing “Hit It Early” for people with more than 300 CD4s unless viral load is high.
The regs, set for a summer release to physicians nationwide, mark a treatment-strategy revolution. “Enormous education of doctors is critical. That should be the PHS’s next step,” said Delaney, a panel member, adding that the report leaves unresolved the knottiest issues: Which drugs to start with, and when. “We don’t know because the trials aren’t being done. The next challenge for activists is to pressure drug companies and researchers to do these studies."