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1996-02-26
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Document 0284
DOCN M9620284
TI A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to
treat HIV-1 infection.
DT 9602
AU Markowitz M; Saag M; Powderly WG; Hurley AM; Hsu A; Valdes JM; Henry D;
Sattler F; La Marca A; Leonard JM; et al; Aaron Diamond AIDS Research
Center, New York University School of; Medicine, New York 10016, USA.
SO N Engl J Med. 1995 Dec 7;333(23):1534-9. Unique Identifier : AIDSLINE
MED/96067436
AB BACKGROUND. Ritonavir is a potent inhibitor in vitro of human
immunodeficiency virus type 1 (HIV-1) protease, which is needed for
virions to mature and become infective. We assessed the safety and
efficacy of ritonavir in patients with HIV-1 infection. METHODS. We
administered ritonavir orally to 62 patients in one of four dosages
during a 12-week trial containing a 4-week randomized,
placebo-controlled, double-blinded phase followed by an 8-week
dose-blinded phase. We assessed the response with serial measurements of
plasma viremia and serial CD4 cell counts. RESULTS. Fifty-two patients
completed the 12-week trial. Diarrhea and nausea were the most common
side effects, and reversible elevations in serum triglyceride and
gamma-glutamyltransferase levels were the most frequent laboratory
abnormalities. Ritonavir had a rapid antiviral effect, with a mean
maximal reduction in the number of copies of HIV-1 RNA per milliliter of
plasma that ranged from 0.86 to 1.18 log in the four dosage groups.
After 12 weeks of treatment, the antiviral effect was partially
maintained, with a mean reduction in plasma viremia of 0.5 log. When we
used a more sensitive assay for HIV-1 RNA in a subgroup of 20 patients,
we found that plasma viremia decreased by a mean of 1.7 log. This
antiviral effect was partly sustained at week 12, with a mean reduction
of approximately 1.1 log. The patients' CD4 cell counts rose during
treatment with ritonavir (median increase, 74 and 83 cells per cubic
millimeter at weeks 4 and 12, respectively). CONCLUSIONS. The protease
inhibitor ritonavir is well tolerated and has a potent antiviral effect,
as shown by substantial decreases in plasma viremia and significant
elevations in CD4 cell counts. Expanded clinical trials of ritonavir are
warranted.
DE Adult Antiviral Agents/ADVERSE EFFECTS/PHARMACOKINETICS/*THERAPEUTIC
USE CD4 Lymphocyte Count/DRUG EFFECTS Double-Blind Method Female
Human HIV Infections/*DRUG THERAPY/IMMUNOLOGY HIV Protease
Inhibitors/ADVERSE EFFECTS/PHARMACOKINETICS/ *THERAPEUTIC USE
HIV-1/*DRUG EFFECTS Male RNA, Viral/BLOOD Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S. Thiazoles/*THERAPEUTIC USE Treatment
Outcome Valine/*ANALOGS & DERIVATIVES/THERAPEUTIC USE CLINICAL TRIAL
JOURNAL ARTICLE MULTICENTER STUDY RANDOMIZED CONTROLLED TRIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).