Dr. Swindells co-authors major study of HIV drugs

Susan Swindells, M.B.B.S.

UNMC’s Susan Swindells, M.B.B.S, was a co-author in the largest study ever conducted to evaluate commonly used HIV drugs. Results from the study were published last week in the New England Journal of Medicine.

The study, which was led by researchers at the University of Pittsburgh School of Medicine, confirmed that one of the most frequently prescribed triple-drug combinations for initial HIV infection is the most effective for suppressing HIV but that a two-drug regimen does perform comparably to popular triple-drug regimens.

“While the study showed that the triple-drug therapy currently preferred by clinicians is indeed the most effective treatment, it also shows that a simpler treatment regimen using fewer drugs does work to treat HIV,” said Dr. Swindells, the Terry K. Watanabe Professor of Internal Medicine in the section of infectious diseases and medical director of the UNMC HIV Clinic.

The study focused in part on nucleoside reverse transcriptase inhibitors (NRTIs), which are one of the first class of HIV drugs approved by the U.S. Food and Drug Administration. Although effective and commonly prescribed, NRTIs can produce severe side effects in some patients.

The study, which included 753 participants at 55 centers, found that the popular three-drug combination of efavirenz plus NRTI therapy was more effective at achieving and maintaining reduction of the virus than another commonly prescribed drug combination of lopinavir-ritonavir plus NRTI.

Interestingly, a two-drug combination of lopinavir-ritonavir plus efavirenz had a similar level of effectiveness as each of the triple-drug regimens that contained NRTIs.

Read the NEJM article Click here to see the article about this study in The New England Journal of Medicine.

“Although all three regimens were well-tolerated and effective, our results showed that efavirenz with NRTIs should still be considered the gold standard regimen for initial HIV treatment,” said Sharon Riddler, M.D., lead author of the study and associate professor of medicine in the division of infectious diseases at the University of Pittsburgh School of Medicine. “The results from the NRTI-sparing regimen have given us valuable reassurance that we can utilize a two-drug therapy regimen based on lopinavir-ritonavir plus efavirenz for patients who are unable to take NRTI due to side effects.”

HIV levels in 24 percent of the participants in the efavirenz-plus-NRTI group returned to detectable levels during the almost two-year study compared to 33 percent of participants in the lopinavir-ritonavir-NRTI group and 27 percent of those in the NRTI-sparing group. All three treatment regimens produced substantial improvements in immune responses.

The study also included contributions from researchers at the University of California, San Diego School of Medicine; Harvard School of Public Health; University College, Dublin, Ireland; the National Institute of Allergy and Infectious Diseases, Division of AIDS; Abbott Laboratories; Bristol-Myers Squibb; Gilead Sciences; Social & Scientific Systems, Inc.; University of KwaZulu Natal, Durban, South Africa; Northwestern University; and the University of California, San Francisco.

The study was conducted as part of the AIDS Clinical Trials Group with funding from the National Institute of Allergy and Infectious Diseases.