Initiating HIV/AIDS Therapy in Treatment-Naïve Patients Are triple-nucleoside regimens ever justified?
	Enlarged Version of Graphics Below	Dr. Wohlfeiler (OC): I think it would be hard in certain ways to justify initiating a patient nowadays on a triple nuc regimen. The thing that's always been interesting about the studies on triple nuke, they actually were very effective medications. They simply weren't as effective and as durable as the same combination with efavirenz added in. But to me that's not surprising. So I think that there really are still reasonably good regimens. But they just aren't as good. Dr. Bellos (OC): There are select patients who would benefit significantly from triple nucleoside regimens, because of their simplicity, the low pill burden, and also because of their efficacy.   See Slide Dr. Kwakwa (OC): I still feel that there is a role for triple nucleoside regimens. There are so many practitioners who have among them good numbers of patients who have done well over the years on triple nucleoside regimens, specifically Trizivir, and again, for those patients who for some reason are unable to take a protease inhibitor or a non-nucleoside, that does provide an option. Dr. Wohlfeiler (OC): One of the things that I've started to do more in place of doing triple nuke, is to actually do quad nuc regimens. Dr. Wohlfeiler (VO): There have been some good studies that have been reported looking at quad nuc regimens, which primarily are AZT, 3TC, abacavir, and tenofovir, and have really shown them in these studies to be as effective as the standard two nucleosides in either a PI or a nonnuke. And that could be a nice compact regimen that spares three classes of antiretrovirals. So I have used that.   See Slide Dr. Kwakwa (OC): I have had some experience with Trizivir and tenofovir, and there are some data out suggesting that that may be an option for some people. Now, that particular regimen, containing abacavir, tenofovir, lamivudine, with AZT as the thymidine analogue, sort of cuts down on some of the fears of cumulative nucleoside toxicity with multiple nucleosides, and the AZT component seems to modulate the resistance a little bit.
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