Triple-nucleoside analog antiretroviral therapy: is there still a role in clinical practice? A review.
The development and widespread clinical use of coformulated abacavir/lamivudine/zidovudine (ABC/3TC/ZDV) as Trizivir represented an important advance in the management of HIV-infected patients, especially those with adherence challenges. With a low pill burden, no food restrictions, limited drug-drug interactions, and a favorable resistance profile, ABC/3TC/ZDV remains an alternative option in the US Department of Health and Human Services Consensus Panel Guidelines as initial treatment in antiretroviral-naive patients. Recent data have shown ABC/3TC/ZDV to be less efficacious in suppressing and/or maintaining suppression of virologic replication compared with efavirenz-containing antiretroviral therapy. Although triple-nucleoside/nucleotide reverse transcriptase inhibitor (t-NRTI) combinations that do not contain a thymidine analog (ZDV or stavudine) have recently shown high virologic failure rates in clinical trials and clinical practice, t-NRTI regimens containing a thymidine analog have consistently been shown to be efficacious.
Kessler
Harold A
HA
Professor of Medicine and Immunology/Microbiology, Associate Director, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois. hkessler@rush.edu.