The Washington Blade - Friday, March 19, 1999
Lisa Keen

In the March issue of Molecular Biology and Evolution, researcher Keith Crandall of Brigham Young University says he analyzed the genetic make up of the HIV in eight patients who took combination therapies for at least two years. The virus was mutating in all eight patients, even those with only "traces" of virus in their systems. But while the virus did mutate quickly and significantly enough to evade the therapies the patients were on, he noted, the virus in each patient "mutated into exactly the same new version."

"This is the first indication," said Crandall, "that the HIV mutations are evolving in parallel. Hopefully, new drugs can catch up to this elusive virus." The finding, if confirmed and coupled with new tests that can identify mutations, might also help doctors and patients decide which drugs to switch to if and when the patients' initial therapies fail.

For women, ritonavir might cause heavy bleeding

A report in the March 6 issue of the British medical journal The Lancet suggests that women taking the protease inhibitor ritonavir sometimes suffer such heavy menstrual periods that they develop anemia.

The report came from a researcher in Denmark treating 10 women with HIV by starting them on combination therapy. Of the 10, three were put on ritonavir, five were put on ritonavir and saquinavir, and two were put on indinavir. None of the women had anemia or menstrual problems before starting therapy, but four developed anemia after starting combination therapies which included ritonavir.

The researcher stopped short of saying ritonavir caused the anemia but said there were no other apparent indications. He urged further research.

New alert over Viagra with protease inhibitors

The March 6 Lancet also carried a report from two doctors in Scotland who say the simultaneous use of the anti-impotency pill Viagra and a protease inhibitor can cause a sudden and dangerous drop in blood pressure, as well as other side effects.

Last May, the Gay and Lesbian Medical Association and AIDS Treatment News warned that the simultaneous use of Viagra with the recreational drug amyl nitrate ("poppers") "could result in sudden and marked lowering of blood pressure, which can be potentially serious or even fatal." Treatment News noted that the use of protease inhibitors and certain other medications, such as erythromycin, ketoconazole, and itraconzole, could also produce a higher level of Viagra in the bloodstream than recommended.

In brief ...

ALL NEW NUKES URGED: Patients are more likely to get their viral loads under control by starting two new nucleoside analogs when they first start taking protease inhibitors, say German researchers in the Feb. 25 issue of the journal AIDS. The report is just one more piece of confusion in the guessing game of what drugs to take and when. Many recent reports have suggested patients stay on their "nukes" unless there's evidence those drugs, specifically, are failing. But doctors studying the records of 901 patients say those who switched to two new nukes at the time they started their first protease inhibitor were more likely to get their viral load count under 500 than patients who switched to only one nuke or stayed on the same drugs.

NEW IDEA ON 'WHEN': There's more confusing news on when to start antiviral drugs, too. Swiss and British researchers say the best time to initiate antiviral therapy is after the patient's viral load has stabilized. Some previous reports have suggested the earlier a patient is started on therapy, the greater the chances of preserving his or her immune system and minimizing the amount of virus that is able to hide in various parts of the body. The new study was published in the Feb. 25 issue of the journal AIDS.

NASAL INFECTION WARNING: Among the new opportunistic infections to watch out for is staphylococcus aureus infection of the nasal cavity. A study at the University of Pittsburgh and elsewhere, reported in the Feb. 2 issue of the Annals of Internal Medicine, found that about 34 percent of 231 patients with HIV carry the S. aureus pathogen. While only about 6 percent of those with the pathogen went on to develop infection, about 35 percent of those who did develop infection died. The researchers noted that preventive medications, such as topical mupirocin and rifampin, are effective against the pathogen.

AIDS TREATMENT TRIALS: For information on AIDS drug treatment trials in the Washington area, call 1-800-TRIALS-A.
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