The Washington Blade; Friday, January 24, 1997
Lisa Keen

GRADUAL DOSING FOR PCP

A report from the National Institute of Allergies and Infectious Diseases and two universities confirms that gradual administration of a drug to prevent pneumocystis carinii pneumonia (PCP) can make the drug more tolerable to people with HIV. The drug, TMP-SMX, is considered a very effective preventive measure against the deadly pneumonia and against toxoplasmosis, but many patients have difficulty tolerating it. Scientists from NIAID and two Ohio universities reported that "significantly fewer" patients had to stop using TMP-SMX when treatment with the drug was administered in gradually increasing doses.

PCP COMPLICATES VIRAL LOAD

A report out of Michigan indicates that a patient's viral load shoots up dramatically when he or she develops pneumocystis carinii pneumonia, but that this increase is apparently only temporary. The study at Henry Ford Hospital in Detroit involved only 10 patients. In those patients, viral loads were around 100,000 just prior to developing PCP, then shot up to about 200,000 at the time their pneumonia was diagnosed. The viral load in most of those patients went back down. The doctors noted, however, that the patients also lost about 40 CD4 cells in relation to the pneumonia.

'SALVAGE THERAPY': 4 DRUGS

A poster from Mercy Hospital in Miami reported a "salvage therapy" for patients with advanced HIV infection -- using two protease inhibitors in combination with two nucleoside analogs. Eight patients were given 800 mg of saquinavir and 400 mg of ritonavir twice a day along with their current doses of two nucleoside analogs. After about three months, seven of the eight patients had experienced about a 100-count increase in CD4 cells, and six out of eight had their viral loads drop from about 80,000 particles per milliliter to below detectability.

BENEFIT IN SURGERY

A study from Montreal found that the amount of virus in the blood decreased threefold in four patients who had their spleens removed. The spleen is one important reservoir for HIV in the body and a site where the virus is known to replicate during the early phases of HIV disease. "We have observed," wrote the doctors from Montreal General Hospital in their poster Thursday, "that splenectomy has a beneficial effect on time to development of AIDS and survival time following HIV-infection." Examining viral load measurements from eight patients who underwent splenectomies, the doctors found that four experienced "moderate" reduction in viral loads following the surgery.

SOME THINGS DON'T WORK

Researchers at the University of Buffalo reported that a study of 35 patients found the drug paromomycin is not effective against cryptosporidiosis in patients with advanced AIDS.

A study from Los Angeles found that short-term administration of beta carotene did not reduce viral load or increase immune system responses in a small group of patients with HIV.

OTHER FINDINGS, IN BRIEF:

--Doctors at the University of California-San Diego reported that the amount of virus in the central nervous system is "almost always lower" than the amount in blood. They also found that the amount of virus in the cerebrospinal fluid, unlike that in the blood, does not increase as HIV disease advances.

--A study from Northwestern University Medical School suggested that a measurement of soluble CD30 is a "relatively easy and inexpensive" alternative to viral load testing and also a good predictor of a patient's prognosis.

--Neither drug has been approved yet for clinical testing, but in the test tube, a new protease inhibitor called 141W94 appears to have good synergistic effect in combination with a non-nucleoside analog called 1592U89, according to a poster from the Albany Medical Center.

--A number of posters yesterday dealt with the concern that some people in the United States may be infected with a strain of HIV-1 (type O) that can go undetected by commonly available HIV antibody tests. A poster from Los Angeles suggested doctors "need a high index of suspicion" when treating patients who test negative but have symptoms similar to HIV infection, particularly if the patients are from West or Central Africa or have had contact with such persons which might transmit the virus.

--A poster from Institute Pasteur in Paris raised the question of "possible environmental transmission" of HIV with a report that the 61-year-old mother and 66-year-old father of a 31-year-old patient with AIDS both tested positive for HIV infection. The report noted that an "extensive epidemiological investigation failed to identify any risk factor" to attribute the parents' infection to the patient. All three had viral strains that appeared to be very closely related.

--Researchers in Los Angeles found that fluconazole, particularly in combination with flucytosine, is particularly successful against cryptococcal meningitis.

970124
WB970109

Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .