Switching drugs regularly improves HIV treatment

NEW YORK (Reuters Health) - When HIV-infected patients alternated their drug regimen every three months, their virus levels stayed down longer than when one regimen was administered continuously.
That news comes from the SWATCH (SWitching Antiviral Therapy Combination against HIV-1) study. Dr. Javier Martinez-Picado, of Hospital Germans Trias I Pujol in Badalona, Spain, and others examined this alternating strategy among HIV patients who were randomized to one of three regimens.
Regimen A consisted of continuous treatment with didanosine, stavudine, and efavirenz. For regimen B, patients were administered zidovudine, lamivudine and nelfinavir. In regimen C, the patients alternated between the other two regimens every 3 months. The results are reported in the Annals of Internal Medicine .
Response to treatment was similar in patients receiving regimen A or regimen B, so the researchers pooled these two groups when evaluating the results.
The rate of virologic failure - that is, a rise in the amount of virus in the blood above a defined level - was 3.5 higher during the following year in the pooled group than in the alternating therapy group.
Dr. Martinez-Picado's group concludes, "Proactive switching and alternation of antiretroviral regimens with drugs that have different resistance profiles might extend the overall long-term effectiveness of first- and second-line treatment options."
In an editorial, Dr. Michael Saag, of the University of Alabama at Birmingham, points out that current drug regimens are more efficacious than the ones used in the SWATCH study.
However, he agrees with Dr. Martinez-Picado's group that further study of proactive switching seems warranted, but that the strategy should not be routine at this time..