The Washington Blade; Friday, March 27, 1998
Lisa Keen

Nevirapine is one of only two non-nucleoside analogs approved for HIV therapy and has been shown to be particularly capable of penetrating the central nervous system, a characteristic that many other antiviral drugs lack. A poster at the Retrovirus Conference in Chicago last month noted that adding nevirapine to the therapy of people with advanced AIDS who have been on the two-drug AZT-ddI combination "resulted in a significant delay in HIV progression or death." It appears that nevirapine (which is marketed by Boehringer Ingelheim Pharmaceuticals as Viramune) improved the antiviral capability of AZT-ddI. But its problem, to date, has been that the AIDS virus appears to mutate easily to resist the drug.

The patients involved in this study were much healthier: they had yet to develop any AIDS symptoms and had CD4 counts of between 200 and 600. Also, none of these patients had yet been on any antiviral therapy.

In their report this week to JAMA, researchers from the study, which involved a number of clinical trial sites, concluded that, in this patient population, the triple-drug therapy had a "substantially greater decrease in plasma viral load and increase in CD4 cell count" compared to either two-drug combination. Triple-drug combinations have already established themselves as being better than two-drug combinations, but the triple-drug combinations tested to date are almost always comprised of a protease inhibitor and two nucleoside analogs. This is one of the first to test a non-nucleoside analog with two "nukes."

The report in JAMA concluded that this particular triple-drug therapy, used at this phase of disease, "can forestall if not prevent the emergence" of an HIV mutation which can resist the drugs. The study was led by respected Canadian AIDS researcher Julio Montaner

It is worth noting that only 66 percent of the 153 patients originally enrolled in the study completed the follow up. But the researchers said this dropout rate "is not unusual."

In brief ...

HIV IN SEMEN: A study in Seattle and Thailand found evidence that HIV can be transmitted in semen even after a man has had a vasectomy. The study of 46 men with HIV but no symptoms found that the procedure did not reduce the amount of HIV in semen. In addition to its implications for prevention, the study suggested that HIV might be harbored in such sites as the prostate gland and urethra in men who have HIV infection but no symptoms. The study was published in the March issue of the Journal of Urology.

HIV IN GENITAL TRACT: A report in the March issue of the Journal of Infectious Diseases reports that, even in the early stages of HIV infection, the AIDS virus is "shed" through the anal-rectal tract by 60 percent of men. Researchers at the University of Washington studied 374 Gay men with HIV infection and found that when they had anal-rectal inflammation, the virus was especially likely to shed, even if their viral loads were low.

TESTOSTERONE PATCH: In addition to its well-known influence on sex drive, the hormone testosterone also affects such things as energy level and mood, and testosterone supplements have been reported to help people with HIV who are suffering from wasting. The ALZA Corporation, a California pharmaceutical company, announced this month that its testosterone patches - which provide testosterone replacement therapy - are now available by prescription in pharmacies around the country. Their cost is about $3.50 per day.

HELPING COGNITION: Researchers at Johns Hopkins Bayview Medical Center reported this month that a drug called Deprenyl can help improve certain mental functions in patients with HIV who suffer cognitive impairment. According to Reuters, the study involved only 36 patients but those taking deprenyl scored "significantly better" on a verbal learning test than those put on some other drug or a placebo. The full study appears in the March issue of the journal Neurology.

BEATING KAPOSI'S SARCOMA: Reuters also reported this week that German researchers have had considerable success in completely resolving KS lesions using a treatment that involves a laser and intravenous administration of a water soluble dye called indocyanine green. The study involved only three patients but the doctors said they were able to completely resolve 18 of 57 lesions and partially resolve the remaining 39. Their report appears in the March issue of the British Journal of Cancer.

NEWS ONLINE: The International Association of Physicians in AIDS Care announced an expansion of its website at www.iapac.org. According to a press release, the expansion will provide more information on the latest in medical treatments.

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