(WB) Efavirenz and protease inhibitors still first-line


(WB) Efavirenz and protease inhibitors still first-line

The Washington Blade - Friday, May 21, 1999
Lisa Keen

In revised guidelines for therapy released this month, the U.S. Public Health Service noted that the use of a drug combination using three nucleoside analogs (abacavir-AZT-3TC) "appears to suppress viral load to a similar degree" to a drug combination using the protease inhibitor indinavir with AZT-3TC. The use of the triple-nuke combo has the advantage, noted the guidelines, of delaying the use of a protease inhibitor and, thus, keeping a powerful weapon in reserve in the patientÆs arsenal of drugs. But the guidelines stopped well short of recommending the three-nuke combo for use as an initial regimen. Instead, the guidelines noted that the durability of the abacavir-AZT-3TC combination is established out to only one year so far, and that abacavir is known to cause a potentially life-threatening reaction in some patients. Therefore, the guidelines indicate that the experts still "prefer" that new patients start with either a protease inhibitor with two nukes, or a combination using the non-nucleoside efavirenz and two nukes.

The guidelines, issued May 5, also noted that the addition of the anti-cancer drug hydroxyurea "may enhance" the anti-HIV effect of various therapies but again stopped short of recommending its addition, saying that it has a number of toxicities and not enough data to recommend it.

The PHS and the Infectious Diseases Society of America issued a draft May 14 of their updated and revised "Guidelines for the Prevention of Opportunistic Infections." The revisions deal primarily with when people with HIV should be taking medications to prevent various opportunistic infections and when they can consider suspending such preventive therapies. For instance, the guidelines suggest patients with CD4 counts under 200 take TMP-SMZ to prevent the deadly pneumocystis carinii pneumonia and suggest they can discontinue the therapy if they are able to keep their CD4 count above 200 for three to six months. (A similar recommendation came from Swiss researchers in the New England Journal of Medicine last month.) The revised guidelines also suggest all people with HIV take a vaccine against bacterial respiratory infections.

To review the updated guidelines (all new recommendations are in bold type) at www.hivatis.org or www.cdc.gov/hiv. Copies of the guidelines are also available by calling 1-800-448-0440, 301-217-0023, or (TTY) 800-243-7012.

In brief ...

NEW PROTEASE ON MARKET: The Food and Drug Administration on April 16 granted "accelerated approval" to Glaxo Wellcome to market its new protease inhibitor amprenavir. The drug will be marketed under the brand name Agenerase. According to an FDA Talk Paper, the drug was approved based on six months research data involving about 700 patients. It showed success with both patients who had taken other drugs and those who had not. According to the Talk Paper, the drug should not be taken with foods that are high in fat.

WARNING ON 3TC AND HBV: Meanwhile, a nucleoside analog marketed by Glaxo Wellcome got a red flag this month. In the May issue of Clinical Infectious Diseases, researchers from Glaxo and two universities noted that, while 3TC has been shown effective against both HIV and Hepatitis B Virus (HBV), patients with both infections may suffer hepatitis flare-ups if or when they stop taking 3TC.

CANADA HAILS NHL DRUG: Sargramostim, a drug used to treat non-HodgkinÆs lymphomas and acute leukemia, is said to extend the antiviral effects of triple-drug combinations against HIV. According to Reuters, a report made earlier this month to the Eighth Canadian Conference on AIDS/HIV Research indicated that the addition of sargramostim (brand name Leukine) to combination therapy enabled patients to better maintain viral suppression.

ANOTHER VIAGRA WARNING: A European drug evaluation agency issued a report April 28 warning that the impotency drug Viagra (generic name Sildenafil) should not be taken with ritonavir and taken only at much-reduced dosages with other protease inhibitors. Apparently the protease inhibitors, especially ritonavir, cause Viagra to be absorbed at much greater concentrations than prescribed.

LOVING PETS: A survey by UCLA of almost 2,000 Gay and bisexual men with AIDS recently found that having a pet decreases depression by providing "a certain level of companionship that helps [the men] cope better with the stresses of their lives." According to Reuters news service, the study appeared in the April issue of AIDS Care magazine.

CHOOSING CONDOMS: A study reported in the March/April issue of Family Planning Perspectives indicates that condoms made of polyurethane are more likely to break than condoms made of latex.

HELPING THOSE WITH VISION LOSS: The Jewish Guild for the Blind has produced a booklet (in English and Spanish) for tips on how to help people with HIV/AIDS who are suffering from vision loss or blindness. The booklet is available free by writing the Guild at 15 W. 65th St., New York, NYC 10023.
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Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1999. AEGIS.