The present highly active antiretroviral therapy (HAART) is very effective against HIV. Still, it has not proven able to tame HIV so that the immune system can take over controlling this virus as it does with others. There is always a small amount of residual HIV that can flare up if treatment is interrupted – even after years of suppressing plasma HIV to below detectable levels (50 copies/mL).
The exact difference between long-term nonprogressors (LTNPs) and those with progressive HIV remains ill defined. The study of the differences in immune response is dependent on the technology available for their detection. A central difficulty has been tracking down and measuring the activity of the CD4+ T-helper cells that respond to HIV infection. These cells, themselves the main target of HIV, orchestrate production of cells that create antibodies (B-cells) or that kill HIV-infected cells (CTLs).
Following recent reports of bone loss and hip problems in patients with HIV and AIDS, the FDA queried the agency’s MedWatch side-effect reporting system and found a strong link between "aseptic" bone death (avascular necrosis) in the hip and the use of Megace in HIV-infected men.
At the 13th International AIDS Conference in Durban, updates on mother-to-child-transmission (MTCT) strategies told a tale of two worlds. In one world, the race to prevent transmission has been almost won; in the other, the most effective regimens still leave women and newborns at loggerheads with a virus that uses every misstep to its advantage.
"Rigor is not the issue of the day, reality is." So spoke Oxford researcher Roy Anderson at a plenary session on "Living with HIV" at this summer's International AIDS Conference. More often than not, neither rigor nor reality won out at the Durban, South Africa gathering.
Eric Goemaere is a physician from Doctors without Borders who heads an HIV/AIDS clinic for infected mothers and community members in Khayelitsha, South Africa.
September 25, 1999: A group of French doctors report on five cases of a rare syndrome of cerebral, neurologic, and/or retinal damage in eight of 2,000 babies born to HIV-positive mothers. This large mother-child cohort had received AZT (Retrovir) or AZT/3TC (Epivir) to prevent HIV transmission during pregnancy and delivery.
Lack of male circumcision has long been linked to the higher HIV prevalence in Africa. First identified in the eighties, the associations between circumcision, sexually transmitted diseases (STDs) and HIV transmission have been extensively studied.
Dan Hays, who was diagnosed with HIV in 1986, has not had the usual disease course. Dan has been living through a nightmare of bone failure and hip replacement surgery with a reluctant San Francisco HMO (Kaiser Permanente) and inexperienced doctors.
On June 6, investigators halted enrollment in ACTG 5057, a trial of the Remune therapeutic vaccine (see the June 2000 Treatment Insider). The halt came barely a month after the trial began. It occurred because of a newly surfaced analysis of data from Remune trial 806, a 2,500-person trial prematurely terminated over a year ago.
On June 19, South Africa's Health Minister, Manto Tshabalala-Msimang launched a new five-year AIDS plan. The plan provides for broader access to HIV testing and counseling, which are now unavailable in almost half of the country's clinics. Prevention activities are a key priority, including expanded information, education and communication campaigns, continued support for vaccine research and enhanced procedures for monitoring trends in HIV and AIDS in the country.
The biggest challenge now facing this nation of 40 million is one that collectively encompasses economic, social, political, and health issues: HIV/AIDS currently affects nearly every citizen either directly or indirectly, with 1,500 to 1,800 new cases diagnosed every day.
Depending on how you look at it, malaria has either a lot or very little in common with HIV. Both diseases kill millions of people each year, and both diseases are scourges of developing nations in Africa, India, Southeast Asia and South America.
Gilead is threatening to retreat from providing compassionate access to its new HIV drug, the nucleotide analog tenofovir. Meanwhile, expanded access is barely on the radar screen for Trimeris and Roche, who are codeveloping the fusion inhibitor T-20. This bleak picture came out of two recent meetings between company officials and community members.
The continuing absence of an HIV vaccine and the lack of access to effective anti-HIV therapy in most parts of the world has sparked increasing demands for measures that provide better protection than condoms. Condoms are widely perceived as unacceptable to many men and to women, too, because they block sensuality and intimacy as well as sperm and microbes.
Kiyoshi Kuromiya, one of the world's leading AIDS activists, died on the night of May 10, 2000, due to complications from AIDS. To the last, Kiyoshi remained an activist, insisting on and receiving the most aggressive treatment for cancer and the HIV that complicated its treatment. He participated fully in every treatment decision, making sure that he, his friends and fellow activists were involved with his treatment every step of the way. He never gave up.
A major worry last winter at the 7th Conference on Retroviruses and Opportunistic Infections was the emergence of drug resistance during transient viral breakthroughs while on therapy. In seeming contradiction, many researchers were interested too in promoting HIV immunity by more extended HIV breakthroughs. Such breakthroughs would be allowed during controlled pauses in therapy, or strategic treatment interruptions (STIs).
With or without treatment, persons with HIV lose dangerous amounts of sulfur, say scientists at the German Cancer Research Center in Heidelberg. Wulf Dröge, a long-time oxidative stress researcher, and colleagues summarized their findings this past February issue of AIDS Research and Human Retroviruses.
Infection with HIV results in progressive immunodeficiency in the majority of individuals over a varying length of time, eventually leading to clinical disease and AIDS. The speed of deterioration in any patient is a complex interaction between the activity of the virus, the response of the immune system and the general health of the person.
Even if treatment interruptions are not beneficial in terms of promoting the body’s own immune defenses against HIV, they may have other uses. Keith Henry, who heads the HIV clinic at St. Paul, Minnesota’s public hospital, echoed a common sentiment when he said, "Aggressive treatment looks good for six months, but continuous drugs might not be wise. We have unplanned treatment interruptions by the hundreds. I’ve given up worrying about them unless the therapy is endangered due to drug resistance. You may have to take breaks anyway, just to let the body recoup."
Abacavir (Ziagen), Glaxo Wellcome’s newest nucleoside analog, is a comparatively nontoxic antiviral agent, except in the few people who are allergic to it. Then it can turn deadly. When allergic, or hypersensitivity, reactions occur, patients are supposed to stop abacavir immediately and not try to go back on. Rechallenging with abacavir results in immediate anaphylactic-type immune reactions.
Indinavir's standard dosing schedule is 800 mg every eight hours. Even if this schedule is strictly followed, the liver degrades indinavir so rapidly that blood levels subside by 98% before the next dose is taken. Taking indinavir along with the protease inhibitor ritonavir, which blocks the CYP3A liver enzyme that metabolizes indinavir, considerably reduces this extreme variation. Concurrent ritonavir also makes possible longer intervals between doses.
English
Disclaimer: The editors have taken all such care as they consider reasonable in preparing this database, but they cannot be held responsible for any inaccuracies or mis-statements of fact contained herein. Inclusion in this database of any information on any treatment, therapy, or clinical trial in no way represents an endorsement of that treatment, therapy, or trial by ÆGiS or any of its sponsors. This data should always be used in conjunction with professional medical advice.