ACTG 384 -- Complicated, but Worth the Work

In this large, multicenter study comparing 6 different initial treatment strategies, AZT + 3TC + efavirenz emerged clearly superior to the other 5 combinations, including 4-drug triple-class regimens.

What is the optimal initial therapy for HIV? Do certain initial regimens increase the likelihood of treatment success with future regimens (a hypothesis called "sequencing")? Answering these two important questions was the major goal of ACTG 384, the full results of which have now been published in two separate articles.

From October 1998 to November 1999, researchers at 58 sites in the U.S. and 23 sites in Italy randomized treatment-naive patients with viral loads of at least 500 copies/mL to 1 of 6 treatment arms:

(1) d4T + ddI + efavirenz
(2) d4T + ddI + nelfinavir
(3) AZT + 3TC + efavirenz
(4) AZT + 3TC + nelfinavir
(5) d4T + ddI + efavirenz + nelfinavir
(6) AZT + 3TC + efavirenz + nelfinavir

In the event of virologic failure or discontinuation…

Reviewing Author

Paul E. Sax, MD

ACTG 384 -- Complicated, but Worth the Work

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Reviewing Author