The primary focus of the Stanford ACTG is the development and evaluation of antiretroviral drug combinations and strategies for the use of highly active antiretroviral therapy in the long-term treatment of HIV infection. The laboratory efforts to evaluate surrogate markers for virus replication included development of plasma HIV RNA PCR and the initial application of quantitative measures of viral replication to clinical trials of antiretroviral drugs and immunotherapeutics. Clinical trial strategies in combination therapies included the leadership of studies of sequential and combination nucleoside analog therapies, early studies combining antiretroviral agents and vaccines and immunotherapeutics and the first trial to use evidence of drug resistance to trigger changes in antiretroviral regimens. In the last few years the laboratory and clinical focus of the Stanford ACTG has concentrated on the use of multiple, sequential combinations in therapeutic strategies that include comparison of two, three and four drug regimens and the use of ultrasensitive HIV RNA and genotypic susceptibility testing to direct the optimal use of highly active therapies.
The aim of these studies is to provide rational and effective new combinations in an optimal sequence for initial and subsequent treatment of HIV infection and to develop salvage therapies in highly drug experienced subjects. In recent years their efforts have increased in outreach and in methods of measuring compliance as well. They intend to continue to bring innovative clinical science to bear on infection but also must continue the patient focus on bringing more women and more minorities into the program as the epidemic changes its pattern making these groups the major target of infection. Because of Stanford and this group's involvement with the major supplier of primary HIV care to Santa Clara and San Mateo Counties, they expect to be able to enter more patients into opportunistic infection protocols as well as the ALLRT and woman's health studies. The unit has advanced virology and pharmacology technology laboratories.
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