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Safety, Tolerability, and Antiretroviral Effects of Ritonavir-Nelfinavir Combination Therapy Administered for 48 Weeks.

Raines, Charles P.; Flexner, Charles; Sun, Eugene; Heath-Chiozzi, Margo; Lewis, Ronald H.; Fields, Cathy; Deetz, Carl; Apuzzo, Linda; Eshleman, Susan H.; Jackson, Brooks J.; Gallant, Joel E.
JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2000
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Objective: To evaluate the safety, tolerability, and anti-HIV activity of ritonavirnelfinavir (RTV-NFV).

Design: Single-site, open-label, nonrandomized, multiple-dose trial of RTV combined with two doses of NFV in protease inhibitor (PI)-naive, HIV-infected patients.

Methods: Mean baseline HIV RNA was 39,500 copies/ml; mean baseline CD4 count was 323 cells/mm3. All patients received RTV at a dosage of 400 mg twice daily. Cohorts I (N = 10) and II (N = 10) received NFV at a dosage of 500 mg and 750 mg twice daily, respectively, for the initial 12 weeks of the study before allowing intensification with reverse transcriptase inhibitors.

Results: The commonest effects of RTV-NFV therapy were study drug-related moderate-to-severe diarrhea (9 patients in cohorts I and II) and drug-related moderateto-severe nausea (4 patients in cohorts I and II). HIV RNA was suppressed in a biphasic manner. At 48 weeks in cohort I, mean HIV RNA reduction was 2.82 log10 copies/ml (standard error [SE] = .61; p = .001; N = 4); mean CD4 cell count increase was 236 cells/mm3 (SE = 67.1; p = .006; N = 4). In cohort II, mean HIV RNA reduction at Week 48 was 2.21 log10 copies/ml (SE = .430; p = .001; N = 8); mean CD4 cell count increase was 120 cells/mm3 (SE = 47.5; p = .03; n = 8). In cohort I patients, 2 of 4 completing Week 48 had HIV RNA <20 copies/ml; and 3 of 4 had HIV RNA <400 copies/ml. In cohort II, 2 of 8 patients completing Week 48 had HIV RNA <20 copies/ml and 4 of 8 had HIV RNA <400 copies/ml. In addition, 3 patients in cohort I withdrew because of virologic failure not thought to be related to poor compliance. Moreover, 15 patients elected to add new reverse-transcriptase inhibitors (RTIs) after week 12.

Conclusions: RTV-NFV with concomitant reverse transcriptase inhibitors is a potential dual-PI option for Pi-naive patients.

(C) 2000 Lippincott Williams & Wilkins, Inc.