The Washington Blade - Friday, January 1, 1999
Lisa Keen

The FDA press release warns that about five percent of patients who take abacavir will experience a "potentially fatal" allergic reaction.

"Symptoms of this reaction may include skin rash, fever, nausea, abdominal pain and severe tiredness," notes the release. It advises anyone experiencing the symptoms on abacavir to stop taking the medication immediately and call his or her doctor. It is also crucial that the patient who experiences an allergic reaction not start taking the drug again. Such re-starts have been associated with life-threatening reactions and death.

The FDA release notes that all nucleoside analogs -- AZT, ddI, ddC, d4T, 3TC, and now abacavir --"can cause" a life threatening building of lactic acid.

According to a press release from GlaxoWellcome, abacavir was studied in combination with AZT-3TC, which are also produced by the company, and in combination with MerckÆs protease inhibitor indinavir plus AZT-3TC.

Mixed reports on immune boosters

German researchers added another mixed report in the Dec. 3 issue of the journal AIDS for the use of the immune booster interleukin-2 in combination with a three-drug antiviral combination. The researchers tested the addition of interleukin-2 (IL-2) to therapy involving the protease inhibitor saquinavir and two nucleoside analogs (AZT-3TC) in 40 patients with CD4 counts of between 200 and 500. While IL-2 triggered "significant increases" in CD4 counts, the increase "steadily diminished" over time. They also found that the treatment did not alter the existence of virus in lymph nodes, but that the risk of certain opportunistic infections seemed three to five times higher in patients not receiving IL-2 with the three-drug combination.

But in the Dec. 17 issue of the journal Nature, researchers at the National Institute of Allergy and Infectious Diseases and in Texas once again held out the hope that the thymus gland -- the gland responsible for producing immune cells -- might be powered up to start producing new cells long past its usual tenure. Until now, most experts have believed the thymus gland was active only early in life and that it basically shut down in adulthood. But NIAID scientists found that, once triple-drug therapy has driven down a patientÆs viral load, the thymus gland is active.

"Therapies that directly improve thymic function may increase the rate of immune reconstitution," said Dr. Richard Koup, the University of Texas researcher who led the study.

In brief

SYPHILLIS TESTING: Meanwhile, a report in the November issue of the journal Sexually Transmitted Diseases indicates that people with HIV infection have a "significantly higher" chance of falsely testing positive for syphilis infection than people without HIV. The study, from Spain, involved analysis of more than 2,500 blood samples. The researchers suggest that doctors routinely administer an HIV antibody test to any patient who gets a false-positive blood test for syphilis.

CMV CATHETER CAUTION: Researchers at Johns Hopkins University in Baltimore published a study in the Dec. 3 issue of the journal AIDS warning that 44 percent of 388 patients with AIDS who received either ganciclovir or foscarnet intravenously through a catheter in their study develop some complication from the catheter itself. They suggest doctors consider using treatment options that do not require such catheters.

VIRAL VARIABILITY: People with HIV are advised to get their viral loads measured regularly to help determine when to initiate therapy and when to switch therapy or add preventive drugs. Viral load tests, however, are often variable, even when taken within days of each other. Researchers at Duke University tried to nail down that variability and, in the December issue of the Journal of Infectious Diseases, report that two-thirds of the variability from test to test is due to "biologic fluctuation" in the patient, one-third is due to differences in the testing materials and procedures.

BRAIN POWER: Three hospitals in New York received a $6 million grant from the National Institutes of Health to conduct research on the effect of HIV on the brain. Specifically, the grant will fund research on the brains of patients who have succumbed to AIDS, according to Associated Press. The hospitals involved include Mount Sinai, Beth Israel, and St. LukeÆs-Roosevelt. AP said the hospitals will attempt to identify patients in very late stages of the illness to undergo some neurological testing before death and to ask them to donate their brains after death. The brain is considered one of the most difficult sites in the body for antiviral drugs to attack HIV.
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