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July 2, 2013

Five-Drug Cocktail Fights HIV Reservoir During Acute Infection

Preliminary findings of a research study involving a five-drug antiretroviral (ARV) cocktail have found that people who start the therapy during acute (or very early) infection experience a marked drop in viral DNA integrated into cells when compared with those living with HIV for some time before beginning the intensified cocktail, MedPage Today reports. Eva Wolf, PhD, of MUC Research in Munich, Germany, presented these two-year results of a seven-year prospective trial at the 7th International AIDS Society (IAS) Meeting in Kuala Lumpur.

While the findings suggest that such a cocktail may help lead to a functional cure by preventing the establishment of the HIV reservoir, the study did not compare a five-drug regimen with the standard three-drug cocktail. So no conclusions can be drawn about whether five drugs would more effectively lead to a functional cure or viral remission. Recently, a study of a group known as the Visconti cohort found that 14 people with HIV in France were able to achieve viral remission after initiating ARVs during acute infection and remaining on the drugs for a median three years before terminating treatment.

The five-drug study recruited 20 participants with acute HIV infection and gave them a regimen of two nucleoside reverse transcriptase inhibitors, a protease inhibitor, the entry inhibitor Selzentry (maraviroc) and the integrase inhibitor Isentress (raltegravir). Investigators also recruited 20 people with longtime HIV infection and gave them Selzentry and Isentress in addition to their regular three-drug regimen.

Two years into the study, the chronic participants essentially had no change in their proviral DNA, which is considered to be a part of the reservoir. The primary infection group saw a median drop of 25 copies per million cells.

Experts not involved in the study criticized it for not comparing three-drug regimens with five-drug regimens and told MedPage Today that prior research has shown that an intensified drug regimen does not have a clear benefit.

To see the IAS poster, click here.

To read the MedPage Today story, click here.

Search: HIV, five-drug cocktail, antiretrovirals, ARVs, 7th International AIDS Society Meeting in Kuala Lumpur, IAS, Eva Wolf, MedPage Today, Selzentry, maraviroc, Isentress, raltegravir, proviral DNA, reservoir.


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