What would you recommend as the best ARV drug sequence for treatment-naive patients? Would PI-sparing options be preferred in view of their AE profile?
Dr. Brian Conway responds: This is a very topical question. Two large studies (ACTG384 in the United States and INITIO in the rest of the world) are addressing this very issue. In these studies, the combinations of two nucleoside analogues with either a protease inhibitor, a non-nucleoside agent or both are being compared as initial therapy. Most importantly, the end point of these studies is a comparison of the time to the failure of the second or third regimen. In addition to the efficacy of the initial regimen itself, It is equally important that it allows for the design of effective follow-up therapy, and these studies will evaluate this "big picture" issue. This is the only way to determine whether there is truly a more appropriate choice of first line therapy for HIV infection.
However, these answers will not be available to us for 18 months or more. So what to do now?
(6/1/2001)
