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Predictors of Outcomes in Patients with HIV Infection Treated with Indinavir, Zidovudine, and Lamivudine
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What is the problem and what is known about it so far?
Human immunodeficiency virus (HIV, the virus that causes AIDS) interferes with the ability to fight infections. Simultaneous use of several anti-HIV drugs can reduce the amount of the virus in the blood and improve patient outcomes. Unfortunately, HIV is not always fully suppressed by such treatments. HIV can then become resistant to the drugs, and the patient must then change to another group of drugs. Two blood tests, the number of CD4 immune cells (a higher number is better) and viral load (a smaller load is better), usually guide doctors in making changes in anti-HIV drug regimens for their patients. To use these tests most effectively to make treatment decisions, doctors need a method to predict which patients are most likely to become resistant to the drugs. Then, physicians could monitor such patients especially closely for early signs of treatment failure and quickly change treatments.
Why did the researchers do this particular study?
To see what information best predicts that a patient will have a long-lasting response to anti-HIV drugs.
Who was studied?
489 HIV-infected patients with CD4 counts lower than 200 who were in a study of treatment with a combination of three anti-HIV drugs: indinavir, zidovudine (or AZT), and lamivudine (or 3TC).
How was the study done?
The researchers collected information on various patient factors, including CD4 counts and viral loads. They obtained this information before starting the drug treatments and after 4 and 8 weeks of drug treatment. The researchers then used this information to predict the response of HIV infection to 24 weeks of treatment.
What did the researchers find?
Patients with higher CD4 counts and lower viral loads after 8 weeks on the drugs were more likely to have continued favorable response to the anti-HIV drugs (lower viral load and fewer AIDS-related illnesses) after receiving the drugs for 24 weeks than were patients who had lower CD4 counts and higher viral loads at 8 weeks.
What were the limitations of the study?
This study looked at only one of many combinations of anti-HIV drugs. The results might not apply to patients taking other drugs.
What are the implications of the study?
Doctors who have started a patient on indinavir, zidovudine, and lamivudine therapy might consider changing to another combination of drugs if the patient has not had an increase in CD4 counts and a reduction in HIV viral load after 8 weeks of treatment.
Article and Author Information
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The summary below is from the full report titled “Predictors of Virologic and Clinical Outcomes in HIV-1–Infected Patients Receiving Concurrent Treatment with Indinavir, Zidovudine, and Lamivudine. AIDS Clinical Trials Group Protocol 320.” It is in the 4 December 2001 issue of Annals of Internal Medicine (volume 135, pages 954-964). The authors are LM Demeter, MD Hughes, RW Coombs, JB Jackson, JM Grimes, RJ Bosch, SA Fiscus, SA Spector, KE Squires, MA Fischl, and SM Hammer.
- Copyright ©2004 by the American College of Physicians
