The Washington Blade; May 8, 1998
Lisa Keen
The guidelines stick with the basic recommendation that, "in general," some form of therapy should be "offered" to a patient when his or her CD4 count goes below 500 or his or her viral load goes above 10,000. Then, based on the patient's individual circumstances and preferences, the guidelines recommend either an "aggressive" or "conservative" strategy.
The "preferred regimen," once treatment begins, notes the guidelines, is still a combination which includes one "potent" protease inhibitor and two nucleoside analogs.
Cox noted that one small change concerns the recommendation for patients who, for whatever reason, are unable to take a protease inhibitor. In those cases, if the patient opts for a combination involving a non-nucleoside analog, the guidelines say clinical trials indicate "a preference for" nevirapine over delavirdine.
Copies of the guidelines are available free by calling 1-800-458-5231 or on the web at www.hivatis.org.
Concern raised over popular new impotency pill
Officials of the Gay and Lesbian Medical Association and the AIDS Treatment News issued warnings last week that people with HIV who are suffering from impotency should not take poppers with the new impotency pill and should carefully monitor themselves for possible side effects with medications commonly taken by people with HIV.
Men with HIV sometimes suffer from a low level of testosterone that can lead to wasting and/or impotency. But GLMA noted that there are a number of causes for impotency and that the new impotency pill, Viagra (made by Pfizer) will not necessarily address all those causes.
According to GLMA and AIDS Treatment News, the simultaneous use of Viagra with the recreational drug amyl nitrate ("poppers") "could result in sudden and marked lowering of blood pressure, which can be potentially serious or even fatal." Treatment News noted that the use of protease inhibitors and certain other medications, such as erythromycin, ketoconazole, and itraconzole, could produce a higher level of Viagra in the bloodstream than recommended.
GLMA officials met with Pfizer representatives to discuss the need for studies to determine what side effects Viagra could have when taken with drugs commonly taken by people with HIV infection.
Meanwhile, both GLMA and Treatment News recommend people with HIV who take Viagra refrain from taking poppers and get a complete medical workup to determine the cause of their impotency. Until more is known about the interaction of Viagra with protease inhibitors and other drugs, they also recommend people consider taking a lower dose of the drug.
In brief ...
17-WEEK MARK: Researchers at the University of Washington reported last month that the viral load of a person at about 120 days (17 weeks) after he or she has become infected with HIV is a good indicator of his or her prognosis. Patients with "high" viral loads at this "inflection point" appear to deteriorate more rapidly, according to the article in the April 15 Annals of Internal Medicine.
BENIGN EYE PROBLEM: A team of ophthalmologists reported in March that some people with HIV have a faint discoloration of retinal tissue which does not appear to be associated with infection but which could prompt extensive laboratory testing. The team said more research will be necessary to identify what causes the infection and suggested in the meantime that patients be tested to rule out syphilis. The report appeared in the March issue of the American Journal of Ophthalmology.
WATCH THAT WATER: Doctors at the University Hospitals of Cleveland reported in the March issue of Infectious Diseases in Clinical Practice that people with HIV have a "significantly shorter" survival time when they suffer from cryptosporidiosis, an infection caused by a parasite, that produces severe and prolonged diarrhea. The parasite is often acquired by drinking contaminated water or through contact with animals.
IMMUNE IMPROVEMENT: A study from Canada reports a "degree of immune restoration" with a two protease inhibitor drug combination of ritonavir and saquinavir. The researchers report in the April issue of the Journal of Infectious Diseases that 41 patients taking the combination had an average CD4 cell increase of 129 after six months.
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