Treatment wonks always advise taking the long view when planning your initial drug regimen. You should consider how the choices you make now will affect what might work for you later. The trouble is that there have been virtually no large studies comparing the effects of different sequences. Finally, useful info has emerged from Glaxo Wellcome’s observational database—specifically, an analysis of 2,100 PWAs’ blood work, comparing results in those first given AZT and later d4T to results in those who did it in the opposite order. Turns out that the AZT-first crowd achieved better viral suppression when later treated with d4T than did those for whom the sequence was reversed. PWAs given d4T first appeared to have a blunted response to down-the-line AZT. (Among those taking either medication for the first time, results were roughly equivalent.) So after all these years, the first drug out may still be the best first drug.
First Things First
October 1, 1999 • By Edited by Bob Lederer and Lark Lands, PhD