RT Journal
A1 Haubrich R, Richman D
T1 Nevirapine, didanosine, and zidovudine for patients with hiv: The incas trial
JF JAMA
JO JAMA
YR 1999
FD January 13
VO 281
IS 2
SP 130
OP 131
DO 10-1001/pubs.JAMA-ISSN-0098-7484-281-2-jac80019
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-281-2-jac80019
AB 
The selection of patients who may best benefit from this regimen is
critical. The authors evaluated factors predictive of an HIV RNA level
of less than 20 copies/mL at weeks 40 to 52 and concluded that
adherence to therapy was an important factor. However, since this
regimen may fail in 55% of patients, the effect of baseline viral load
on attaining undetectable viral load should be considered. Using 
Figure 3, we entered the regimen, baseline viral load (< or
≥10,000 copies/mL), adherence, and
outcome (HIV RNA level < or ≥20 copies/mL
at 40-52 weeks) for the 2 more potent regimens (zidovudine plus
didanosine and zidovudine plus didanosine plus nevirapine) into a
database. Two patients in the triple-therapy group were not included in 
Figure 3. Adherence influenced the percentage of patients with HIV RNA
levels of less than 20 copies/mL at 40 to 52 weeks; 13 (29%) of 45
adherent patients vs 5 (17%) of 29 nonadherent patients had
undetectable levels (P=.2). However, 9 (53%)
of 17 patients with baseline viral loads of less than 10,000
copies/mL had undetectable levels at weeks 40 to 52 vs 9 (16%) of 57
patients with higher baseline viral loads
(P=.004). The effect of baseline viral load
was also seen when patients receiving triple therapy
alone were considered. While 8 (73%) of 11 patients with baseline HIV
RNA levels of less than 10,000 copies/mL had undetectable viral
loads at weeks 40 to 52, only 8 (30%) of 27 with higher baseline
values achieved this goal (P = .03, Fisher exact test). Thus,
in univariate analysis, treatment regimen, adherence, and baseline
viral load were associated with achieving undetectable viral loads.