Health

3-drug cocktail best for treating HIV, study shows

A three-drug cocktail used by many HIV-infected people proved clearly superior to other combinations at treating new patients in the biggest head-to-head comparison of AIDS medications.

The combination works better and longer, is easier to take and suppresses the virus more quickly, the international study found, offering confirmation of what many AIDS specialists believe.

Among the study's other, more surprising findings: Four drugs are not necessarily better than three.

The study was the first to determine the best sequence for drug combinations - critical information because patients' medication must be changed when the virus mutates and begins to resist the first drugs.

Preliminary findings from the research changed the U.S. Department of Health and Human Services' guidelines for initial HIV treatment and doctors' prescribing habits.

With 20 HIV drugs on the market and hundreds of possible combinations, the latest findings could simplify doctors' decisions.

"It confirms what physicians have suspected for a long time," said Jose Zuniga, president of the International Association of Physicians in AIDS Care.

The study involved patients at 58 hospitals and clinics in the United States and 23 in Italy. Researchers led by doctors at Harvard and Stanford universities tested several three- and four-drug combinations of six HIV medicines.

They found the best combination for people getting their first HIV medication was efavirenz, lamivudine and zidovudine, better known as AZT. The last two drugs are taken in a combination pill under the brand name Combivir. Efavirenz is sold as Sustiva.

The combination is one of the U.S. government's three preferred initial regimens, and Zuniga says it's the most prescribed AIDS drug combination in the country.

"I've had fantastic success with this," said Dr. Patricia Kloser, a professor of public health at the University of Medicine and Dentistry of New Jersey in Newark. "Even when resistance shows, people are hesitant to go off it because it's so easy to take: one pill in the morning and two at night, end of story."

The findings, contained in two research papers, were reported in today's New England Journal of Medicine.

The testing began in 1998. Nearly 1,000 patients were followed an average of 28 months, during which six patients each on the three- and four-drug cocktails died.

One paper compared different three-drug cocktails in 620 patients.

A drug combination is deemed a failure when the level of virus in a patient's blood rises, the number of key immune cells called CD4 cells drops or the drugs cause toxic effects, including damage to the nervous system, liver, pancreas and gastrointestinal tract.

After about 11 months, a failure occurred in 10 percent of patients on zidovudine/lamivudine/efavirenz, versus 30 percent to 40 percent of those on other regimens.

A second paper compared the patients on the three-drug cocktails with 360 getting four-drug combinations. To researchers' surprise, four drugs were no better than the zidovudine/lamivudine/efavirenz combination.

WASHINGTON - Knee replacement surgery is a safe and cost-effective treatment for persistent pain and disability, and increasing numbers of patients are seeking it at an earlier age, a panel of experts told the National Institutes of Health on Wednesday.

The panel found the procedure, in which the moving parts of the knee are replaced with a man-made joint, is performed in about 300,000 patients a year in the United States. That number is expected to grow as the American population ages, the panel said.

Dr. E. Anthony Rankin of Providence Hospital in Washington said the procedure is not for everyone. "It's major elective surgery that carries a variety of important risks, but it often offers dramatic relief after other therapies fail," he said.

The panel said studies show the failure rate is about 1 percent per year over a 20-year period. Most patients who get the operation are elderly Medicare beneficiaries, but the age of patients has declined in recent years, the panel said. Today, it's not uncommon for 50-year-olds to get new mechanical knees.

Scientists say they have turned mouse embryonic stem cells into primitive sperm cells - and then used the sperm cells to fertilize eggs.

The scientific team's work could offer insights into male infertility and boost human stem cell research.

The sperm cells were not fully developed sperm, but rather tail-less precursors. When they were injected into eggs, the eggs developed into embryos. Scientists are studying whether such embryos can develop into live-born mice.

The team was led by Dr. George Q. Daley of Harvard Medical School. Its findings were published online Wednesday by the journal Nature.

Embryonic stem cells can develop into virtually any kind of cell of the body, and scientists hope to use them someday to create replacement parts to treat illnesses such as Parkinson's disease and diabetes. The new work also involved embryonic germ cells, which appear in early embryos and mature into sperm or egg cells.

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