Combination therapy for patients with HIV-1 infection: the use of dual nucleoside analogues with protease inhibitors and other agents.

This report reviews the design and preliminary results of ongoing and new studies that are evaluating novel antiretroviral drug combinations for the treatment of patients with HIV-1 infection. The studies reviewed in this report are: (1) Selection of Thymidine Analogue Regimen Therapy (START) I and II which compare three-drug combinations of stavudine (d4T), lamivudine (3TC), and indinavir, or d4T, didanosine (ddI), and indinavir versus zidovudine (ZDV), 3TC, and indinavir; (2) ATLANTIC, a study that compares d4T and didanosine (ddI) in combination with a third agent, either 3TC, nevirapine, or indinavir; and (3) the OZCOMBO studies: OZCOMBO 1, which compares two-drug combinations of d4T and 3TC, d4T and ddI, and ZDV and 3TC, all in combination with indinavir, and OZCOMBO 2, which compares two-drug combinations of d4T and ddI, ZDV and ddI, and ZDV and 3TC, all in combination with nevirapine. Preliminary results from these studies suggest that novel dual-nucleoside analogue reverse transcriptase inhibitor pairs, d4T and 3TC, d4T and ddI, and ZDV and ddI, as part of three-drug combinations, achieve antiretroviral effects comparable to ZDV- and 3TC-based three-drug combination regimens.