Abacavir-Lamivudine-Zidovudine vs Indinavir-Lamivudine-Zidovudine in Antiretroviral-Naive HIV-Infected AdultsA Randomized Equivalence Trial

Abstract

The current goal of antiretroviral therapy is to achieve prolonged suppression of human immunodeficiency virus (HIV) replication. The rational selection of antiretroviral agents used to initiate the treatment of HIV infection is critical for 2 reasons. First, the magnitude and duration of antiretroviral response is greatest for initial therapy, and second, sequencing of therapy must allow for effective second-line treatment regimens if the initial therapy fails. A conventional approach to initial antiretroviral treatment has been with 2 nucleoside analogues and a protease inhibitor.^1-3 While protease inhibitor–containing regimens have contributed substantially toward delaying progression of the acquired immunodeficiency syndrome (AIDS) and increasing duration of survival,^4-7 several problems can limit their long-term effectiveness and contribute to incomplete viral suppression. These problems include poor tolerability, metabolic toxic effects, drug interactions due to inhibition or induction of cytochrome P450 enzymes, and incomplete adherence due to the complexity of dosing regimens.^8-11 Incomplete viral suppression in the presence of selective pressure exerted by antiretroviral therapy promotes the development of resistance mutations, which may confer cross-resistance to other drugs of the same class.