Concentration-controlled compared with conventional antiretroviral therapy for HIV infection
作者:
Courtney Fletcher,
Peter Anderson,
Thomas Kakuda,
Timothy Schacker,
Keith Henry,
Cynthia Gross,
Richard Brundage,
期刊:
AIDS
(OVID Available online 2002)
卷期:
Volume 16,
issue 4
页码: 551-560
ISSN:0269-9370
年代: 2002
出版商: OVID
关键词: Antiretroviral therapy;combination therapy;drug concentrations;pharmacokinetics;therapeutic drug monitoring
数据来源: OVID
摘要:
ObjectivesTo demonstrate the feasibility of a concentration-controlled approach to combination antiretroviral therapy, and to compare the virological responses and safety of this strategy versus conventional fixed-dose therapy.DesignA prospective, randomized, 52 week, open-label trial of concentration-controlled compared with conventional dose zidovudine, lamivudine, and indinavir therapy conduced in a university-based general clinical research center in the United States.PatientsForty antiretroviral-naive individuals with plasma HIV-RNA levels > 5000 copies/ml.InterventionsZidovudine, lamivudine, and indinavir plasma concentrations were measured in all participants. Doses were adjusted in those assigned to concentration-controlled therapy to achieve levels equal to or greater than target values.Main outcome measuresThe proportion of patients who achieved the desired drug concentrations, the proportion of patients with HIV-RNA levels < 50 copies/ml at week 52, and safety and tolerance in the concentration-controlled versus conventional therapy arms.ResultsSignificantly more concentration-controlled recipients achieved the desired concentration targets for all three drugs: 15 of 16 concentration-controlled recipients compared with nine of 17 conventional recipients (P= 0.017) had HIV-RNA levels < 50 copies/ml at week 52. No difference was observed in the occurrence of drug-related clinical events or laboratory abnormalities between the two treatment arms.ConclusionConcentration-controlled therapy implemented simultaneously for three antiretroviral agents was feasible, as well tolerated as conventional therapy, and resulted in a greater proportion of recipients with HIV-RNA levels < 50 copies/ml after 52 weeks. These findings provide a scientific basis to challenge the accepted practice of administering the same dose of antiretroviral agents to all adults, ignoring the concentrations actually achieved.
点击下载:
PDF
(355KB)
返 回