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| |  Non-Active Antiretrovirals Should Not Be Part of Effective Salvage Regimens: Presented at IAS By Ed Susman CAPE TOWN, South Africa -- July 23, 2009 -- Researchers suggest that when physicians put together final options for the treatment of highly-experienced HIV-positive patients who are experiencing treatment failure, that inactive components of the treatment -- usually nucleoside reverse transcriptase inhibitors (NRTIs) -- be dropped from the new treatments. "Keeping inactive nucleoside reverse transcriptase inhibitors in the regimen increases the cost of treatment and the risk of drug interactions and toxicity," said Benoit Trottier, MD, Clinique Medicale l'Actuel, Montreal, Quebec. "Using non-active nucleoside reverse transcriptase inhibitors for multidrug resistance patients did not improve virologic outcomes." In a poster discussion on July 21 at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Dr. Trottier said that among 116 highly-experienced HIV-positive patients in the study whose viral load was not being controlled, adding 1, 2, or 3 inactive drugs to their regimens failed to make a difference in suppression of the virus. "The viral response was inversely correlated with the number of nucleoside reverse transcriptase inhibitors prescribed," he said. "The more nucleoside reverse transcriptase inhibitors prescribed, the lower the proportion of patients with a virologic response." The virologic response was 100% among the 9 patients not given a non-active NRTI; the response was 89% for patients given 1 non-active drug; 76% for those given 2 non-active drugs, and 40% if 3 non-active drugs were in the campaign (P = .009). "While it seems that inactive drugs are not needed among patients who can suppress their virus to undetectable levels with newer medications, there is still a possibility that these inactive drugs are having some impact among those who have an incomplete response," said Cal Cohen, MD, Community Research Initiative of New England, Boston, Massachusetts, who moderated the session, but did not participate in the study. Dr. Trottier said that even though physicians are aware that a drug may not be active, many physicians maintain the drugs in the regimen while adding on other treatments. "They are often used in salvage regimens despite the lack of scientific evidence," he said. Dr. Trottier said there might be some reasons for continuing use of the inactive drugs. "The inactive drugs might also increase sensitivity to other nucleoside reverse transcriptase inhibitors or might be needed in order to build a regimen that otherwise might have only 1 or 2 drugs," he said. By and large, however, Dr. Trottier said, "This study suggests that non-active nucleoside reverse transcriptase inhibitors or any other non-active antiretroviral should not be part of effective salvage regimens." [Presentation title: Should Inactive Nucleoside/Tide Reverse Transcriptase Inhibitors (NRTIs) Still Be Used in Salvage Regimens, With New Classes/Generations of Antiretrovirals in Three-Class-Experienced, Multidrug Resistant Patients? Abstract TUPDB205]
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