The optimism about induction-maintenance therapy within AIDS research circles peaked a year ago for a number of reasons. One factor was the development of new antiretroviral compounds over the last few years, including protease inhibitors. This therapy, however, has proven toxic and extremely difficult to take consistently. In other fields of medicine and HIV treatment, several cancers and opportunistic infections are successfully treated with this approach.
Patients can only take so many drugs in a day.
Unfortunately, in both studies a significant proportion of volunteers in the maintenance study arms, who were receiving various combinations of double or single drug treatments, experienced a rebound in viral load relative to those who continued the triple combination therapy. These study results have tempered optimism for the CTN investigators who came together at a workshop in 1997 to design an induction-maintenance trial. Those still committed to the possibilities of induction-maintenance therapy, have argued the induction phase of this approach must be stronger and longer before the maintenance phase is implemented. Switching to entirely new drugs for the maintenance regimen is another suggestion. Most recently, in an attempt to address some of the concerns with earlier studies, the ADAM Study, based in the Netherlands, opted for a quadruple drug regimen for a 6.5 month induction phase.