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December 22/29, 1999

Adefovir for the Treatment of HIV Infection: If Not Now, When?

Author Affiliations

Author Affiliation: Infectious Diseases Division, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa.

JAMA. 1999;282(24):2355-2356. doi:10.1001/jama.282.24.2355

An increasing concern in the management of human immunodeficiency virus (HIV) infection is the limited effectiveness of salvage treatment regimens for patients in whom approved drugs have failed to control viral replication because of drug toxicity or the emergence of drug-resistant viral strains.1,2 Estimates are that triple-drug therapy fails to suppress plasma HIV RNA to less than 400 copies/mL in 10% to 40% of patients starting their first treatment regimen.3 Treatment failure is more frequent (20%-60%) in patients taking a second or third treatment regimen.3,4 Not unexpectedly, HIV strains that are resistant to all currently approved classes of antiretrovirals—including nucleoside reverse transcriptase (RT) inhibitors, nonnucleoside RT inhibitors, and protease inhibitors—have been identified in heavily treatment-experienced patients. Although the prevalence of such resistant viruses is not well defined, 70% of samples referred to one testing laboratory showed resistance to all 3 drug classes.5 This is alarming because safe and effective salvage regimens for multiclass resistant virus have yet to be identified. New drugs with activity against drug-resistant strains of HIV are urgently needed.1