[Virological evaluation of treating HIV-infected patients with (combinations of) antiretroviral drugs at the Amsterdam Academic Medical Center, 1996/'97].
OBJECTIVE
First clinical virological evaluation of anti-HIV treatment with HIV reverse transcriptase (RT) and protease inhibitors.


METHODS
Descriptive.


METHODS
Academic Medical Centre of the University of Amsterdam, the Netherlands.


METHODS
From January 1, 1996, until May 1, 1997, HIV-RNA levels were determined in sequential serum or plasma samples obtained sequentially of 384 patients over a period of 3.1 years on average (minimum 0.5, maximum 10 years). Of these patients 318 had sustained treatment for at least 6 months. The effect on HIV-RNA serum or plasma levels was evaluated in this particular group, of which 224 (70.4%) had been pretreated with antiretroviral drugs (experienced patients) and 94 (29.6%) had not (naive patients).


RESULTS
Of the naive patients 8.5% were treated with a combination of two, 89.4% with three and 2.1% with four anti-HIV drugs. Preceding their current treatment, an average of more than two other anti-HIV regimens had been administered to the experienced patients. From 1987 until May 1997 a total of 834 treatments were registered among the 224 patients: 202 mono, 223 double, 340 triple, 60 quadruple and 9 other combination treatments. After six months 84% of the triple combination treatments in the naive patients and 61% in the experienced patients resulted in RNA levels < or = 10(3) copies/ml (p = 0.008). Of 68 patients who failed on treatment 36 (52.9%) showed resistance associated mutations in HIV reverse transcriptase. In 6/43 (14%) of these patients resistance associated mutations in protease were found as well. Genotypic resistance could not always be confirmed phenotypically.


CONCLUSIONS
Our preliminary results indicate that in a majority of cases triple combination treatment including at least one HIV protease inhibitor was successful. Nevertheless, in 16% of the therapy-naive and 39% of the therapy-experienced patients the anti-HIV effect of treatment was insufficient.
de Wolf
F
F
Academisch Medisch Centrum, Amsterdam.
de Jong
J J
JJ
Hertogs
K
K
Danner
S A
SA
Lange
J M
JM
Goudsmit
J
J
D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D010641:Phenotype; D011480:Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood / Q000187:drug effects*; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D000998:Antiviral Agents; D011480:Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors
Virologische evaluatie van behandeling van HIV-geïnfecteerden met (combinaties van) antiretrovirale middelen in het Academisch Medisch Centrum Amsterdam, 1996/'97.