United Press International; Wednesday July 1 5:06 PM EDT
Ed Susman, UPI Science News

At the 12th World AIDS Conference in Geneva, doctors said protease inhibitors' side effects and the emergence of several new treatments for HIV-infection means that doctors have more choices to offer their patients. The guidelines are published in Wednesday's issue of the Journal of the American Medical Association.

Dr. Robert Schooley, a leading AIDS researcher from the University of Colorado School of Medicine, Denver, presented the guidelines to a packed audience of AIDS doctors, patients and activists.

He said, "Guidelines are just that: guidelines. Quite clearly there are other alternatives available for treating HIV-infected patients."

Over the past two years, combination treatments using a protease inhibitor and other classes of anti-retroviral drug were found to dramatically lower virus levels in the bloodstream. The triple-drug combinations quickly became the standard of care.

However, in the last year significant side effects have been found in patients taking protease inhibitors for long terms. Those side effects "buffalo humps" on the back, protruding stomachs, high cholesterol levels and skin disorders _ have led doctors and patients to become wary of the drugs, even though protease inhibitors clearly are life-saving for many patients. During the same period, however, other new classes of drugs were developed, and now share center stage with the protease drugs.

To hammer home the new flexibility in HIV treatment, members of the guidelines panel tackled four hypothetical cases in which a first-line treatment was to be considered. Doctors suggested that in one case it was too early to treat the patient; in other cases doctors recommended treatments involving combinations with non-nucleoside drugs, multiple nucleoside analogues, Gr combinations involving immune system boosters such as the hydroxyurea.

Protease inhibitors, non-nucleosides and nucleoside analogues are anti-retroviral drugs which attack the HIV in different ways. Use of drugs from different classes are believed to be able to prevent drug resistance from developing. Panel member Dr. Julio Montaner, director of Canadian HIV Trials Network and professor at the University of British Columbia, said all the treatments are equally effective in reducing patients' virus levels in the blood.

Dr. David Butcher, assistant clinical professor of medicine at the University of Kansas, Kansas City, applauded the emphasis in the guidelines on the importance for joint treatment decisions hammered out between doctor and patient. Butcher says, "The physician-patient relationship is coming to the front as a big aspect in HIV treatment." Butcher and Montaner both say that questions of adherence to complicated HIV treatment regimens have to be discussed with patients before determining the best treatment for each individual.

Montaner says simplified treatments possible with new investigational drugs will help patients adhere to the regimens and get better results.

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