The Fickle (and Unforgiving) Fashion of Antiretroviral Therapies:
Early treatment choices and their unintended consequences.
| ‘Early’ AZT 1990 |
No survival benefit found; resistant mutant associated with more rapid progression. |
| AZT+3TC 1994 |
Double resistance after one year; reduced sensitivity to other nucleoside reverse transcriptase inhibitors. |
| AZT+ddI 1995 |
Combination not proven superior to ddI monotherapy; AZT mutant not forestalled. Selection of multi-ddN resistant mutants. |
| AZT+3TC+IDV 1996 |
Indinavir “break-throughs” highly resistant to other proteases; resistant mutants fully ‘fit.’ |