indinavir-sulfate and adefovir-dipivoxil

Topics: Acquired Immunodeficiency Syndrome; Adenine; Adult; Alkynes; Benzoxazines; Cyclopropanes; Dideoxynucleosides; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Genotype; HIV-1; Humans; Indinavir; Male; Nelfinavir; Organophosphonates; Oxazines; Phenotype; Reverse Transcriptase Inhibitors; Treatment Failure

Management of antiretroviral treatment failure in patients receiving protease inhibitor (PI)-containing regimens is a therapeutic challenge.. To assess whether adding a second PI improves antiviral efficacy of a 4-drug combination in patients with virologic failure while taking a PI-containing regimen.. Multicenter, randomized, 4-arm trial, double-blind and placebo-controlled for second PI, conducted between October 1998 and April 2000, for which there was a 24-week primary analysis with extension to 48 weeks.. Thirty-one participating AIDS (acquired immunodeficiency syndrome) Clinical Trials Units in the United States.. A total of 481 human immunodeficiency virus (HIV)-infected persons with prior exposure to a maximum of 3 PIs and viral load above 1000 copies/mL.. Selectively randomized assignment (per prior PI exposure) to saquinavir (n = 116); indinavir (n = 69); nelfinavir (n = 139); or placebo twice per day (n = 157); in combination with amprenavir, abacavir, efavirenz, and adefovir dipivoxil.. Primary efficacy analysis involved the proportion with viral load below 200 copies/mL at 24 weeks. Other measures were changes in viral load and CD4 cell count from baseline, adverse events, and HIV drug susceptibility.. Of 481 patients, 148 (31%) had a viral load below 200 copies/mL at week 24. The proportions of patients with a viral load below 200 copies/mL in the saquinavir, indinavir, nelfinavir, and placebo arms were 34% (40/116), 36% (25/69), 34% (47/139), and 23% (36/157), respectively. The proportion in the combined dual-PI arms was higher than in the amprenavir-plus-placebo arm (35% [112/324] vs 23% [36/157], respectively; P =.002). Overall, a higher proportion of nonnucleoside reverse transcriptase inhibitor (NNRTI)-naive patients had a viral load below 200 copies/mL compared with NNRTI-experienced patients (43% [115/270] vs 16% [33/211], respectively; P<.001). Baseline HIV-1 hypersusceptibility to efavirenz (< or = 0.4-fold difference in susceptibility compared with reference virus) was associated with suppression of viral load at 24 weeks to below 200 copies/mL (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.62-7.33; P =.001), and more than 10-fold reduction in efavirenz susceptibility, with less likelihood of suppression at 24 weeks (OR, 0.28; 95% CI, 0.09-0.87; P =.03).. In this study of antiretroviral-experienced patients with advanced immunodeficiency, viral load suppression to below 200 copies/mL was achieved in 31% of patients with regimens containing 4 or 5 new drugs. Use of 2 PIs, being naive to NNRTIs, and baseline hypersusceptibility to efavirenz were associated with a favorable outcome.

Topics: Adenine; Adult; Alkynes; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Benzoxazines; Carbamates; CD4 Lymphocyte Count; Cyclopropanes; Dideoxynucleosides; Disease Progression; Double-Blind Method; Drug Resistance, Viral; Female; Furans; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Nelfinavir; Organophosphonates; Oxazines; Proportional Hazards Models; Reverse Transcriptase Inhibitors; Saquinavir; Sulfonamides; Treatment Failure; Viral Load

The Community Research Initiative on AIDS is currently screening potential volunteers for clinical trials. Current studies include the effects of protease inhibitors on blood sugar, the effectiveness of twice a day Crixivan dosing, the effectiveness of adefovir dipivoxil in combination with protease inhibitors, the effectiveness of DMP 266 in combination with several drugs, and the effects of Oxandrolone on weight loss in women. Participants will be reimbursed after enrollment. Contact information and eligibility requirements are included.

Topics: Adenine; Alkynes; Anabolic Agents; Anti-HIV Agents; Benzoxazines; Blood Glucose; Clinical Trials as Topic; Cyclopropanes; Drug Therapy, Combination; Female; HIV Infections; HIV Protease Inhibitors; Humans; Indinavir; Male; Organophosphonates; Oxandrolone; Oxazines; Patient Selection; Reverse Transcriptase Inhibitors; Weight Loss