The Washington Blade - September 3, 1999
Lisa Keen

The "Guidelines for the Prevention of Opportunistic Infections" deal primarily with when people with HIV should start taking medications to prevent various infections and when they can consider suspending such therapies.

As expected, the recommendations indicate that doctors may consider taking patients off preventive medication against pneumocystis carinii pneumonia when the patient's CD4 count is greater than 200 for at least three months. TMP-SMZ is identified as the preventive drug of choice against PCP.

For the first time, the guidelines note that there is no effective preventive therapy against human herpes virus 8, associated with Kaposi's sarcoma. Review the updated guidelines (all new recommendations are in bold type) at www.hivatis.org or www2.cdc.gov/mmwr/mmwr_rr.html. Copies are also available by calling 1-800-448-0440, 301-217-0023, or (TTY) 800-243-7012.

In brief ...

WATCH THE HEAT: Scientists from Spain reported in the August issue of the journal Clinical Infectious Diseases that the development of kidney stones in patients taking indinavir seems to occur more frequently during summer months than winter months. Noting that excessive perspiration can predispose a person to kidney stones, they examined the occurrence of kidney stones among 758 patients on HIV taking indinavir to see how frequently stones occurred compared to each day's temperature, humidity, and atmospheric pressure. The doctors asked the patients to drink at least the recommended 1.5 liters of bottled water per day and other variables were accounted for. The researchers found that the occurrence of kidney stones "closely correlated with temperature but not with humidity or atmospheric pressure." And they found that patients who developed the kidney stones were more likely to have had chronic viral hepatitis. Overall, they noted, about 13 percent of patients developed kidney stones, compared to the incidence in the general population, which averages about half a percent per year. The researchers urged people taking indinavir to be sure to drink at least 1.5 liters of water every day.

AND THE CATHETERS: Another report from Spain, also in the August issue of Clinical Infectious Diseases, warns that about 50 percent of AIDS patients who are wearing implantable catheters for easy administration of intravenous medications are experiencing infections from the devices. The article suggests steps doctors can take to recognize such infections quickly and to fight infections once they occur.

COUNTING CD4s: Researchers from Germany and England recommended last month that doctors more frequently monitor patients with "persistently low" CD4 counts even when their viral loads are below the level of detection. The study involved 588 patients with HIV who were taking triple-drug therapy. Fifty-two percent of the patients had their viral loads rebound to above 500; most of those had CD4 counts below 300. Their report is in the August issue of the Journal of Infectious Diseases.

DUAL BENEFIT: Protease inhibitors not only fight HIV, they fight thrush, the opportunistic infection that attacks the mouth and throat (and, in women, the vaginal area). According to a study from Italy, published in the August Journal of Infectious Diseases, patients taking protease inhibitors see a "marked decrease in the incidence of oral candidiasis, sometimes soon after initiation of therapy and well before the number of CD4 T cells recover.

MARK SEPT. 15: People interested in learning more about the fat distribution phenomenon sometimes associated with protease inhibitor use can call in their questions ù or just listen ù as a group of four experts talk via teleconference about the latest news on the matter Wednesday, Sept. 15, 8 p.m. The call is free but participants must register (first names only) in advance. The experts are Donald Kotler, Andrew Carr, Roger Anderson, and Ronald Baker, and the title of the teleconference, sponsored by HIV Treatment Live, is "New Developments in HIV-Related Lipodystrophy." To register, call 1-800-880-5121 between 9 a.m. and 5 p.m., Monday through Friday. Participants can also submit questions in advance through e-mail at HivTxLive@aol.com.

MARYLAND DRUG LIST: The Maryland Department of Health and Mental Hygiene announced Aug. 19 that its AIDS Drug Assistance Program (ADAP) will now cover three more drugs. New on the list of covered medications are amprenavir (a protease inhibitor), compazine (to relieve nausea), and nystatin (to treat fungal infections). The department also announced that it will provide coverage for people with HIV who are "in the process of applying for Medicaid or the Maryland Pharmacy Assistance Program." For more information, call 410-767-6535 or 800-205-6308.
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