The Washington Blade - October 13, 2000
Lisa Keen

New York researcher-clinician Roy Gulick asked an audience of physicians and infectious disease experts attending the annual Interscience Conference on Antimicrobial Agents and Chemotherapy, "Have you had a patient ask to do an STI?"

According to a summary of the conference, provided by the American Medical Association, 60 percent of the audience members, all of whom had electronic buttons through which to record their responses, came back with the response "yes."

But when Gulick asked how many had helped their patients develop such a strategy, noted AMA reporter Dennis Blakeslee, only about one-third had done so.

The strategy has received considerable attention in recent months but its efficacy is supported, thus far, by only about a dozen patients who have experienced some measure of success.

The enthusiasm for the strategy, however, is shared by a great many more patients who must endure the side effects and pill-taking burdens of the complicated combination therapies that are keeping people with HIV alive.

But Gulick, said Blakeslee, told the ICAAC audience that he believes enough data exists to form guidelines for how to proceed with such a strategy. One of those guidelines, said Gulick, is that strategic treatment interruption works only in patients who have begun antiviral therapy very early after infection. That's because it appears that very early therapy preserves a patient's immune system enough that, when he or she goes off medication for a short period of time, the immune system is strong enough to control the virus - for at least a short period of time.

In chronically infected patients, Gulick said, the strategy does not appear to provide any benefit other than temporary relief from taking pills, and stopping medication in that phase of disease, he said, could cause harm.

Renewed call for early intervention

Researchers at Massachusetts General Hospital reiterated last month their belief that very early initiation of antiviral therapy means better results in surviving HIV infection.

In the Sept. 28 issue of the journal Nature, Dr. Bruce Walker and colleagues reported that their studies continue to show that people with HIV who start therapy within days or weeks of becoming infected maintain stronger immune systems than those who start therapy only after having been infected for some time.

Walker's group stopped therapy in eight patients who had begun taking antivirals soon after infection. While their viral loads rose to the level of detectability within one to five weeks:

* in three patients, the viral loads soon went back down without therapy to below 5,000 (and two of the three have been able to stay off therapy for seven to eight months), and

* in the five patients who had to restart therapy after the first treatment interruption, when they stopped therapy the second time, the viral load rose to a lower level than it did the first time. And then their viral loads, too, dropped below 5,000 without therapy (and two of these five patients were able to stay off therapy for five and six months with viral loads below 300). Walker's group said that starting antiviral therapy in the acute phase of infection, coupled with strategic treatment interruptions, appears to constitute "successful containment" of HIV.

"While Walker's group was one of the first to urge very early intervention with antivirals, his group and others have been discussing the feasibility of treatment interruptions for about the last two years. Walker said this latest report constitutes "the first time that anyone has shown that the immune system can successfully be manipulated to keep HIV under control."

"Diagnosing HIV infection and beginning antiviral treatment as early as possible," notes the report, "can make a fundamental difference in the way the immune system handles the virus."

In brief...

RACIAL DISPARITY DUE TO TIMING: A study in the Sept. 25 Archives of Internal Medicine reported that a vaccine against streptococcus pneumonia appeared to be three times more effective in white people with HIV than it was in black people.

But the study, conducted by researchers at the U.S. Centers for Disease Control and Prevention and the University of California-Berkeley, seemed to indicate that the vaccine was less effective among blacks because of "low use of the vaccine in this population" and "immunization [of blacks] at more advanced stages of immunosuppression." The researchers urged use of pneumococcal vaccine in HIV-infected persons and highlight a clear need for strategies to improve vaccine-induced protection against the deadly pneumonia.

001013
WB001001

Always watch for outdated information. This article first appeared in 2000. 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, 2000. 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. .