Stephen J.LurieMD, PhD, Senior Editor
To the Editor: Dr Hammer and colleagues1 reported that increasing to a more potent regimen (including 2 protease inhibitors [PIs] and efavirenz) improved virologic outcome at 24 weeks among patients with human immunodeficiency virus (HIV) who had not improved on a PI-based regimen. Despite these intensive, complex regimens (including up to 40 pills daily), only 47% of patients receiving 2 PIs and who were naive to efavirenz achieved an undetectable plasma HIV-RNA load. It would be helpful to know more about the factors, apart from regimen potency, that also contributed to successful therapy such as prior therapy, prior patient adherence, on-study tolerability, and on-study adherence. A potent but intolerable regimen is doomed to fail, especially for longer periods, as is the prescription of a complex regimen to a patient who has been unable to adhere to similar regimens in the past.2
Carr A. Virologic Outcomes of Complex Drug Regimens for Human Immunodeficiency Virus. JAMA. 2002;288(19):2405. doi:10.1001/jama.288.19.2405-JLT1120-3-1
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