Triple nucleoside analogue antiretroviral therapy: expanding the treatment approaches for management of HIV infection.
The expanding range of drug options for the management of persons with HIV infection and concerns about the long-term safety of some treatment approaches has precipitated the HIV treatment community to examine a wider range of treatment approaches. One new therapeutic approach is to consider using three nucleoside analogue reverse transcriptase inhibitors, particularly as initial therapy. Recent data comparing triple nucleoside analogue therapy with established 'standard of care' triple therapy regimens have demonstrated similar antiviral effects and tolerability for such regimens. Efficacy and tolerability of triple nucleoside therapy has been demonstrated up to 96 weeks of therapy. This approach has advantages over conventional two nucleoside plus either a protease inhibitor or non-nucleoside reverse transcriptase inhibitor in terms of drug interactions and maintenance of multiple class options. It creates regimens which are, for the most part, compact, twice daily and non-food dependent. Specifically, this approach has already become widely established for individuals for whom drug interactions exclude the use of protease or non-nucleoside antiretrovirals. Triple nucleoside analogue therapy is likely to represent an attractive option for both physicians and patients; its use in clinical practice is likely to further expand.
Moyle
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Chelsea and Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK.