Plan A for suppressing HIV in the heavily treatment-experienced has generally meant mega-HAART regimens, a smorgasbord of five to nine drugs that can cause serious side effects, a huge pill burden and a scheduling nightmare. Searching for an effective Plan B led Spanish researchers to "cyclic" therapy, in which two different three- to four-drug regimens are alternated monthly. The theory sounded good: About the time resistance-creating mutations begin to develop against one regimen, a switch is made to the other. Indeed, six of the 11 PWAs who completed 24 weeks of therapy achieved undetectable viral loads. But more than a third of the participants withdrew because of side effects, which tend to be most problematic in the first few weeks of therapy. Since this approach switches the drugs every four weeks, the body has to readjust constantly. The result seems to be unacceptable symptoms in many. Plan C anyone?
A Vicious Cycle
October 1, 1999 • By Lark Lands, PhD and Edited by Bob Lederer