Document 0835
 DOCN  M95A0835
 TI    Combination antiretroviral therapy. Back to the future.
 DT    9510
 AU    Lange J; Academic Medical Centre, University of Amsterdam, The;
       Netherlands.
 SO    Drugs. 1995;49 Suppl 1:32-7; discussion 38-40. Unique Identifier :
       AIDSLINE MED/95339781
 AB    HIV causes chronic infection and is associated with persistent viral
       replication and a high viral mutation rate. It is an illusion to think
       that monotherapy with any antiretroviral agent will have a major and
       lasting impact on this disease. Monotherapy with antitubercular agents
       led to dramatic improvements in treatment, but the development of drug
       resistance meant that these improvements were of only short duration,
       and hence it was concluded that drugs should be combined. The response
       to the limited efficacy of nucleoside analogue monotherapy in HIV
       infection has in many instances been the stance that 'currently
       available antiretrovirals are no good; it is better not to treat'. In
       addition, regulatory insistence on clinical end-points has also hampered
       antiretroviral drug development. It is implied that antiretrovirals must
       be tested in populations with fairly advanced HIV infection, in whom the
       least success may be expected. The regulatory bind has also resulted in
       artificial and counterproductive treatment guidelines. Common sense and
       experience in infectious diseases dictate that treatment should hit hard
       and early. No study published thus far undermines the concept that early
       therapy is better than late therapy or that a tolerable combination of
       drugs with additive or synergistic anti-HIV activity is better than
       nucleoside monotherapy. Promising data have been generated in trials on
       combinations of zidovudine plus didanosine or zalcitabine; a combination
       of zidovudine and lamivudine (3TC) may be even more promising.(ABSTRACT
       TRUNCATED AT 250 WORDS)
 DE    Acquired Immunodeficiency Syndrome/*DRUG THERAPY  Antiviral
       Agents/*ADMINISTRATION & DOSAGE  Drug Therapy, Combination  Human  Virus
       Replication/DRUG EFFECTS  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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