HIV combination therapies: are two drugs enough?

The renowned scientific journal The Lancet HIVpublished in its latest issue, an editorial by Drs. Daniel Podzamczer and Arkaitz Imaz, researchers from the group of respiratory infections and in the immunocompromised host of the Institute of Biomedical Research of Bellvitge (IDIBELL) and members of HIV and STD Unit of the Infectious Diseases Service of Bellvitge University Hospital Through this prestigious forum of opinion, the authors discuss the advantages and validity of new antiretroviral therapies that combine two drugs - instead of the usual three - for certain subgroups of HIV-infected patients.

Antiretroviral therapies against HIV have evolved a lot in recent times. Dr. Podzamczer, Head of Unit, explains that "a few years ago, treatments could consist of up to 14-15 pills a day; that certainly made treatment compliance difficult and implied several side effects that patients tolerated just because they had no other choice. Today, HIV is considered a chronic disease and as such, while waiting for a cure, we are looking for the most effective, well tolerated, and patient-friendly treatments possible".

International guidelines consider triple antiretroviral therapies - a combination of three drugs – as a standard supported by a great number of clinical studies of efficacy and safety. "At present, it is difficult to improve what we have: there are very effective treatments, mostly well tolerated and some are formulated in a single pill taken once a day" the researcher says. "However, studies published in recent years show that some combinations of two drugs could be as effective as triple combinations with additional advantages: effectively reducing the number of drugs decreases the risk of interactions with other medications the patient may be taking, may result in fewer side effects and allows us treat patients with a history of previous failure and resistance mutations Another important aspect to consider is the reduction in treatment costs. Quoting Dr. Podzamczer, "in recent years and due to the economic crisis, the price of the treatment has become a relevant factor to consider when choosing the optimal treatment for a given patient".

In the future, and while new lines of research are still working to find a cure for this disease, standard antiretroviral therapies may include combinations of two drugs, but for the moment and in the absence of definitive data on efficacy and safety such treatments are reserved for certain patients; Bellvitge Hospital, they represent 10-15% of the total. Dr. Podzamczer concludes: "In any case, what we want to convey through this editorial is that we are at a good point regarding the development of antiretroviral drugs, drug combinations and therapeutic strategies, which will allow us to choose the best option for each individualized patient in the coming years."

Image: Drs. Daniel Podzamczer and Arkaitz Imaz