At the recent 7th European Conference on Clinical Aspects and Treatment of HIV Infection, in Lisbon, Portugal several papers were presented as well as in other meetings and journals. Below are some of the papers that were reported in the Doctor's Guide.
Just click on the URL links to read the articles.
1) HAART Has Reduced Risk Of Opportunistic Infections, Researcher Says <http://www.pslgroup.com/dg/1405b6.htm>
Many of the opportunistic infections which were once regarded as AIDS-defining diseases now occur far more rarely thanks to the advent of highly active anti-retroviral therapy, an expert reports.
2) Famvir Approved In Canada For Herpes Treatment In People With HIV <http://www.pslgroup.com/dg/13f7e6.htm>
Health Canada has approved Famvir (famciclovir) for the treatment of recurrent herpes simplex infections in HIV-positive patients.
3) Researchers Find Rapid Rebound Of HIV And Reappearance Of HIV
<http://www.pslgroup.com/dg/13f11e.htm>
Researchers have found that the HIV virus quickly rebounds to substantial levels when therapy with combinations of anti-HIV drugs and interleukin-2 is stopped.
4) Improved Tolerance And Compliance To Treatment With Didanosine
<http://www.pslgroup.com/dg/13f10e.htm>
Researchers have developed a new formulation of didanosine that appears to be easier to use and may produce fewer side effects than the currently approved formulation
At the recent 7th European Conference on Clinical Aspects and Treatment of HIV Infection, in Lisbon, Portugal several papers were presented as well as in other meetings and journals. Below are some of the papers that were reported in the Doctor's Guide.
Just click on the URL links to read the articles.
1) HAART Has Reduced Risk Of Opportunistic Infections, Researcher Says <http://www.pslgroup.com/dg/1405b6.htm>
Many of the opportunistic infections which were once regarded as AIDS-defining diseases now occur far more rarely thanks to the advent of highly active anti-retroviral therapy, an expert reports.
2) Famvir Approved In Canada For Herpes Treatment In People With HIV <http://www.pslgroup.com/dg/13f7e6.htm>
Health Canada has approved Famvir (famciclovir) for the treatment of recurrent herpes simplex infections in HIV-positive patients.
3) Researchers Find Rapid Rebound Of HIV And Reappearance Of HIV
<http://www.pslgroup.com/dg/13f11e.htm>
Researchers have found that the HIV virus quickly rebounds to substantial levels when therapy with combinations of anti-HIV drugs and interleukin-2 is stopped.
4) Improved Tolerance And Compliance To Treatment With Didanosine
<http://www.pslgroup.com/dg/13f10e.htm>
Researchers have developed a new formulation of didanosine that appears to be easier to use and may produce fewer side effects than the currently approved formulation
Other Recent articles include the following:
5) Immunotoxin Eliminates T Cells Latently Infected With HIV-1 In Vitro <http://hiv.medscape.com/reuters/prof/1999/10/10.07/sc10079a.html>
From experimental work as well as clinical experience with both HCV and HIV, we know that people with these infections have cells in which the virus is hiding but not actively reproducing. Therefore, when a viral load test is done, the virus is undetectable because at that time the cells with the inactive virus is not producing and releasing viruses into the blood stream. At some point these inactive or latent viruses can be reactivated and begin to reproduce more viral particles. These cells with latent virus are frequent referred to as Trojan horses. Read entire article at above URL.
6) HIV/AIDS Treatment Update:
This article discusses the first line and secondl line therapy available for the treatment of HIV infection. It discusses alternatrive therapies and how to plan so that the doctor can take advantage of clinical and laboratory testing to select the best combination for patients. It also discusses salvage therapy if the person fails first and second line therapy. Read about the HIV/AIDS treatment update at:
<http://hiv.medscape.com/Medscape/HIV/TreatmentUpdate/1999/tu09/pnt-tu09.html>
7) Summary of update on new class of drugs for HIV/AIDS Therapy
State-of-the-art combination of antiretroviral therapy has resulted in extending and improving the lives ofHIV infected patients., There are 3 classes of drugs involved in this therapy called (1) Nucleoside Reverse Transcriptase Inhibitor (NRTI), (2) non-nucleoside Reverse Transcriptase Inhibitors (NNRTI), and (3) Protease Inhibitors (PI). All 3 of these types of drugs work on HIV only after it has invaded and injured the cells. Combinations of three drugs from the more than a dozen drugs in these categories are used currently as standard therapy. This intense therapy is referred to as Highly Active Anti-Retroviral Therapy or HAART. However the longer these drugs are used, the more multi-drug resistant HIV organisms that develop. When this happens, the disease flares up. This has MD’s worried about how to treat these patients who have developed these multi-drug resistant HIV infections. Because of this, drug research has been looking at other means of treating HIV infections. One of the new approaches is to prevent the fusion of the virus to the cell membrane. The virus must fuse with the receptor sites on the cell membrane before it can invade the cell. If this fusion can be stopped, the virus will be unable to enter the cell and therefore unable to multiply. It will be exposed to other drugs circulating in the plasma and killed more readily. The CD4 cells will be spared and will be able to help the body mount an immune reaction to the infection. Such drugs that block the fusion of the virus to the cell are called fusion inhibitors.
The fusion inhibitor most studied clinically is referred to as T-20. A phase II study of this drug has been briefly reported in the Dec. 1, 1999 issue of the Journal of the American Medical Association.. Patients in the study had been treated with multiple anti-retroviral drugs (Median number of drugs used in treatment = 11) and more than 90% of them had been exposed to all 3 classes of drugs currently available for therapy. They all had high plasma levels of HIV RNA and low levels of CD4 lymphocytes (the cells destroyed by HIV). These patients received T-20 and 4 oral anti-retroviral drugs selected on the basis of their drug history and genotype analysis of their virus. Of the 55 patients completing 16 weeks of therapy 30 (60%) had clinically significant reduction in their plasma viral load and 20 (36%) had less than 400 copies/ml of HIV RNA (a very low viral load). Because of the success of this phase II study, a multi-institutional phase III trial with many more patients is expected to begin this coming year.
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) New Treatment Guidelines For HIV Updated By AIDS Specialists (Read complete article at <http://www.pslgroup.com/dg/159c96.htm>)
An international group of AIDS specialists, consisting of a 17-member physician panel, released updated guidelines for treating HIV disease in adults. This was reported in the Jan. 19, 2000 issue of The Journal of the American Medical Association. The new guidelines take into account the availability of new anti-retroviral drugs and expanded therapy choices.
The most important changes in the new recommendations and important observations are:
(1) The decision to initiate therapy must be individualized for each patient. The widespread use of potent anti-retroviral therapies has improved the quality of life and survival of people infected with HIV. However, there are difficulties with current regimens including long-term side effects of the drugs. These issues suggest that deferral of therapy may sometimes be advantageous.
(2) Choices for initial regimens have increased with the three new drugs that became available in the past year and more in clinical trials. Recommended combinations include (1) a protease inhibitor and two nucleoside reverse transcriptase inhibitors (nRTIs); (2) a nonnucleoside and two nRTIs; and (3) two protease inhibitors (where one is used to enhance the pharmacologic properties of the other) and two nRTIs.
(3) Assessing and supporting patient adherence to the prescribed anti-viral regimen are critical to successful therapy. Drugs and regimens with more convenient administration requirements (e.g., twice daily dosing) are now available to help in this area.
(4) Therapy is generally recommended for patients with a confirmed plasma HIV RNA level (viral load) above 30,000 copies per milliliter, irrespective of CD4 cell count, and for patients with CD4 cell counts below 350, irrespective of HIV RNA level.
(5) Both CD4 cell and HIV RNA levels are important for evaluating treatment response. The HIV RNA levels should decrease rapidly after therapy is initiated. Failure to achieve a target level of less than 50 copies per milliliter after about 16 to 24 weeks should raise concern about poor adherence, inadequate drug absorption or drug resistance. Increases in CD4 cell counts reflect reconstitution of the immune system.
(6) Based on clinical and immunologic benefit in patients with advanced disease and few or no remaining anti-retroviral options, it is reasonable to continue treatment as long as possible.
9)
Drug Resistance Testing Recommended After HIV Treatment Failures (Read entire article at <http://www.pslgroup.com/dg/15b37a.htm>)
New data suggest that HIV drug resistance testing early after loss of suppression may be useful in identifying components of a failing regimen that might be useful in a new combination regimen
Loss of HIV suppression during potent antiretroviral therapy may be connected to a number of factors, including suboptimal drug potency, according to a study published January 12 in the Journal of the American Medical Association
