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DG DISPATCH - CROI: Efavirenz Combination Keeps Viral Loads Undetectable For Two Years By Ed Susman Special to DG News CHICAGO, IL -- February 7, 2001 -- About 80 percent of patients on efavirenz-based combination therapy had persistent undetectable HIV viral loads for two years, a researcher reports. Dr. Richard Levy of DuPont Pharmaceuticals Company, Wilmington, Delaware, who presented the study data at the 8th annual Conference on Retroviruses and Opportunistic Infections, said that the median time to virologic failure on the efavirenz regimen might be as long as six years. "First regimen highly active antiretroviral therapy (HAART), particularly a regimen of efavirenz and two nucleoside reverse transcriptase inhibitors, leads to long-term virologic success," Dr. Levy said. In the study, patients receiving efavirenz with zidovudine and lamivudine were compared to other cohorts -- one of efavirenz and the protease inhibitor indinavir, and another of indinavir plus zidovudine and lamivudine. After two years, the analysis of the time-to-virologic failure showed that 80 percent of the 422 patients on the efavirenz triple combination regimen maintained undetectable viral loads, compared with 65 percent of the 429 dual combination patients and 60 percent of the 415 patients on the indinavir triple combination. Dr. Levy noted that patients who began therapy with a higher baseline CD4 counts -- an indication of a stronger immune system -- performed even better than did the overall cohort. About 90 percent of 68 patients with greater than 500 CD4 cells at baseline still had undetectable virus after two years if they were on the efavirenz triple combination compared with about 70 percent on the other arms of the study. About 75 percent of the patients with less than 200 CD4 cell counts at baseline remained at undetectable viral levels on the triple efavirenz regimen compared with around 50 percent of these patients on the other regimens. "With use of potent regimens," Dr. Levy said, "the risk of virologic failure is low. If trends observed during the first two years continue, the median time to virologic failure will exceed six years for patients on the efavirenz-zidovudine-lamivudine regimen." Virologic failure in the study was defined as a confirmed plasma HIV-1 RNA level greater than or equal to 50 copies/mL as determined by the Roche Ultrasensitive Amplicor HIV-1 Monitor Assay. E-mail this page to a friend or colleague! To print, use this version