SAFETY AND EFFICACY OF LAMIVUDINE-ZIDOVUDINE COMBINATION THERAPY IN ZIDOVUDINE-EXPERIENCED PATIENTS - A RANDOMIZED CONTROLLED COMPARISON WITH ZIDOVUDINE MONOTHERAPY
S. Staszewski et al., SAFETY AND EFFICACY OF LAMIVUDINE-ZIDOVUDINE COMBINATION THERAPY IN ZIDOVUDINE-EXPERIENCED PATIENTS - A RANDOMIZED CONTROLLED COMPARISON WITH ZIDOVUDINE MONOTHERAPY, JAMA, the journal of the American Medical Association, 276(2), 1996, pp. 111-117
Objective.-To compare the safety and efficacy of 2 doses of lamivudine
given in combination with zidovudine with continued zidovudine monoth
erapy. Design.-Double-blind, randomized, multicenter, comparative tria
l of 223 patients treated for 24 weeks. Setting.-Patients from 32 hosp
itals in Europe were enrolled th roughout a 1-year period. Patients.-A
dult human immunodeficiency virus type 1 (HIV-1)-positive, zidovudine-
experienced (greater than or equal to 24 weeks prior zidovudine) patie
nts with CD4(+) cell counts between 0.10 and 0.40x10(9)/L (100-400 cel
ls/mu L). Intervention.-Patients received either 200 mg of zidovudine
every 8 hours, 150 mg of lamivudine every 12 hours plus zidovudine, or
300 mg of lamivudine every 12 hours plus zidovudine for 24 weeks. All
patients were then allowed to receive zidovudine and open-label lamiv
udine combination therapy. Twelve patients withdrew because of adverse
events during the 24-week treatment period. Main Outcome Measures.-Ef
ficacy was measured by evaluating immunological and viral load changes
, and safety was assessed by evaluating clinical manifestations and la
boratory indexes of toxic effects. Results.-Patients receiving low- or
high-dose combination therapy had greater treatment effects compared
with patients receiving continued zidovudine monotherapy during the fi
rst 24 weeks as documented by changes in CD4(+) cell counts (+0.04 vs
+0.03 vs -0.02x10(9)/L, respectively; P<.001); log,, HIV-I RNA as meas
ured by the Roche assay (-0.96 vs -0.77 vs +0.07 copies/mL, respective
ly; P<.001) or log(10) HIV-1 RNA measured by the quantitative nucleic
acid sequence-based amplification assay (-0.59 vs -1.06 vs -0.02 copie
s/mL, respectively; P<.011); and immune-complex dissociated (ICD) p24
antigen (-74% vs -68% vs +27%, respectively; P<.001). There were no st
atistically significant differences in viral measurements, in CD4(+) c
ell counts, or in safety profile between the groups receiving 2 doses
of lamivudine in combination with zidovudine. The effects on CD4(+) ce
ll counts and ICD p24 antigen were sustained throughout 48 weeks for p
atients continuing combination therapy. Patients switching to combinat
ion therapy at week 24 showed improvement. Conclusions.-In zidovudine-
experienced HIV-1-infected patients, combination treatment with lamivu
dine and zidovudine is well tolerated and provides greate; and more su
stained increases in CD4(+) cell counts and decreases in viral load th
an continued zidovudine monotherapy.