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Short-Term Measures Of Relative Efficacy Predict Longer-Term Reductions In Human Immunodeficiency Virus Type 1 RNA Levels Following Nelfinavir Monotherapy

John Mittler, Paulina Essunger, Geoffrey J. Yuen, Neil Clendeninn, Martin Markowitz, Alan S. Perelson

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ABSTRACT We calculated the relative efficacy of treatment, defined as the rate of decline of virus levels in plasma during treatment relative to the rate of decline during highly potent combination therapy, in human immunodeficiency virus type 1 (HIV-1) patients treated for 56 days with different doses of the protease inhibitor nelfinavir. Relative efficacies based on the rate of decline of HIV-1 RNA levels in plasma over the first 14 to 21 days correlated with drug dose and viral load reduction by day 56. Calculation of relative treatment efficacies over the first 2 to 3 weeks of treatment can allow rapid assessment of new antiretroviral agents and dosing regimens, reducing the need to keep subjects in clinical trials on monotherapy for prolonged periods of time. Relative efficacy may also serve as a measure of treatment efficacy in patients in initiating established therapies.