United Press International - July 6, 2002
Ed Susman, UPI Science News

"This research has to put into question widely-held assumptions that infection with human immunodeficiency virus (HIV) can be easily treated with available drugs," said Dr. Frederick Hecht, associate clinical professor of medicine at the University of California, San Francisco.

He said that people who engage in high-risk unsafe sexual practices could become infected with a virus that would mean they would no longer be candidates for standard first-line treatment.

"We are seeing some patients who may need to begin therapy with salvage regimens," Hecht said at a press briefing discussing new research in the Journal of the American Medical Association (JAMA), held in conjunction with the opening of the 14th World AIDS Conference.

In his study, Hecht analyzed the virus that infected 225 patients in San Francisco who showed signs of having been newly infected with HIV. He looked at the genetic makeup of the virus in three groups of patients -- 80 percent of whom were men: those infected in 1996-1997; those infected in 1998-1999 and those infected in 2000-2001.

While just 1 or 2 percent of patients were infected with strains resistant to two classes of drugs in the early time periods, 13.2 percent of patients in the last group had resistant viruses, Hecht said.

The researchers used resistance-testing equipment developed by the South San Francisco company ViroLogic. Dr. Nicholas Hellmann, vice president of clinical research at ViroLogic said, "As an increasing number of people become infected with drug-resistant HIV, it is important that physicians know their patients' drug resistance profiles from the start to avoid ineffective or needlessly onerous treatment regimens."

Hecht said that when patients who did not have resistant virus were treated with multi-drug regimens, it took about a month for their blood levels of the virus to be suppressed to undetectable levels. However, it took an average of three months to reach that level in the patients that had a resistant virus.

In addition to patients who had a virus resistant to two classes of drugs, Hecht said one patient among the patients he studied had a virus that was resistant to all three major classes of antiretroviral medications: Nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors -- all of which interfere in different aspects of the life cycle of the virus.

"The study indicates that in the United States, there is a need to continue to focus on preventive messages," said Dr. Kevin DeCock, director of Kenya operations for the Centers for Disease Control and Prevention. He authored a commentary on the worldwide HIV epidemic in the special AIDS-related JAMA issue released in conjunction with the international conference.

DeCock said that recent studies suggest that the cohesiveness of the gay community in the United States in advocating a preventive, safe sex message is fraying as part of the nationwide "tiredness that confronts preventive measures."

What the patients with a resistant virus may face is a regimen that includes handfuls of pills taken throughout the day, said Dr. Scott Hammer, professor of medicine and epidemiology at Columbia University in New York.

In the study he presented Saturday, Hammer said he put 389 patients whose virus was uncontrolled by medicine on grueling therapies that included two protease inhibitors, a non-nucleoside reverse transcriptase inhibitor, a nucleoside reverse transcriptase inhibitor and a drug from a fourth class -- nucleotide inhibitors.

About 35 percent of patients taking the two protease inhibitor combinations compared with 23 percent of those put on a single protease inhibitor cocktail of medications were able to control their virus blood levels. Control of viral levels has been associated with fewer infections that are hallmarks of the disease and with improved immune system functioning.

Hammer said recent improvements in drug delivery could markedly reduce the "pill burden" that his patients faced -- some of them required 40 or more pills a day. "These studies suggest that resistant virus is something to worry about," Dr. Yank Coble, president of the American Medical Association, told United Press International.

"There are a lot of people who believe that HIV infection is highly treatable and even curable," said Coble, an endocrinologist who practices in Jacksonville, Fla. He said a renewal of safe sex prevention messages is warranted.
020706
UP020703

Always watch for outdated information. This article first appeared in 2002. 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, 2002. 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. .