title: Induction-maintenance antiretroviral therapy: proof of concept.
abstract: OBJECTIVE
  To investigate the concept of aggressive initial combination therapy followed by reduction to a less demanding maintenance regimen with respect to its potential for sustaining viral suppression.
  
  
  METHODS
  Durable viral suppression to < 20 HIV RNA copies/ml plasma was achieved with zidovudine-nevirapine-didanosine (ZDV-NVP-ddl) therapy. Potential for sustained antiviral response was explored for patients who began with ZDV-NVP-ddl and subsequently interrupted ddl.
  
  
  METHODS
  Antiretroviral-naive patients were treated with ZDV-NVP, ZDV-ddl, or ZDV-NVP-ddl. Viral load was measured with the Amplicor assay (limit of quantification 400 copies/ml) and by the Ultra Direct assay (limit of quantification 20 copies/ml) when the Amplicor result was < 500 copies/ml. Treatment adherence for each drug was recorded, including all dose adjustments.
  
  
  RESULTS
  Five patients who had begun treatment with ZDV-NVP-ddl discontinued ddl for at least 6 weeks after achieving viral load levels below detection. All were documented to have sustained their viral load at < 20 copies/ml during the ddl interruption. Two patients permanently discontinued ddl, both with sustained viral load below detection for more than 1 year while treated with ZDV NVP. In contrast, no patient initially receiving ZDV-NVP was able to maintain viral load below detection for sustained periods; none had viral load below detection after week 12 of treatment.
  
  
  CONCLUSIONS
  After induction with ZDV-NVP-ddl, patients were able to sustain viral suppression with a regimen (ZDV NVP) that was only transiently effective as initial therapy. There was no evidence of virologic escape, even with the most sensitive measure of plasma viral load.
authors.affiliation: Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut 06877, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Hall
authors.forename: J G
authors.initials: JG
authors.lastname: Montaner
authors.forename: P
authors.initials: P
authors.lastname: Reiss
authors.forename: D
authors.initials: D
authors.lastname: Cooper
authors.forename: S
authors.initials: S
authors.lastname: Vella
authors.forename: C
authors.initials: C
authors.lastname: Dohnanyi
authors.forename: M
authors.initials: M
authors.lastname: Myers
authors.forename: J
authors.initials: J
authors.lastname: Lange
authors.forename: B
authors.initials: B
authors.lastname: Conway
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016049:Didanosine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D019829:Nevirapine / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D019829:Nevirapine; D016049:Didanosine