Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
Information Bulletin #14 - March 2002
The once a day, coated version of the nucleoside analog drug ddI, which is called Videx EC, must be taken at least one and a half hours before, or at least two hours after eating. Even small amounts of food can decrease the levels of the drug, which is already approved by the FDA. This version of ddI is a capsule, as opposed to the sometimes difficult to stomach chewable or dissolvable Videx tablets. Videx EC also presents less concerns about drug interactions because it does not contain a buffer. On a related note, the newly approved drug Viread increases levels of Videx in the blood by up to 40%. It's unclear what effect Viread would have on Videx EC levels.
Garlic can greatly lower blood levels of the protease inhibitor Saquinavir (Invirase, Fortovase). Research conducted by, among others, our friend Dr. Judith Faloon at the NIAID, suggests that this effect lasts at least several days after stopping the garlic supplements. Some people take garlic supplements to lower cholesterol levels. A study conducted earlier by this team showed that St.John's Wort, sold as all kinds of herbal tinctures and preparations, can decrease levels of the drug Crixivan, also a protease inhibitor.
Abusing Tina has become even more common, from New York to Miami. Since the Sept.11 terrorist attacks syphilis is skyrocketing and new cases of multiple drug resistant HIV, and acute hepatitis are not uncommon, according to one local doctor with an ever growing caseload. Tina also goes by the names speed, bumps, and crystal methamphetamine. The number of people seeking treatment for alcohol and substance abuse issues has also increased significantly since September 11th.
Merck's HIV DNA vaccine studies are moving forward. Although human study results have not yet been published, animal study results show that the vaccine provokes a big T cell directed immune response. An antibody response alone is not believed to be strong enough to deal forcefully with HIV. Merck has also announced that they are starting long awaited studies of a new type of anti- HIV drug called an integrase inhibitor. Several studies also support taking Crixivan (indinavir) in combination with small amounts of another protease inhibitor, Norvir (ritonavir) to overcome Crixivan resistance. In these studies, the two drugs were taken only twice a day, and there were no food restrictions.
Anemia is far more common in people with HIV than it is appropriately treated. Several studies strongly suggest that untreated anemia leads to a poorer quality of life, and a worse prognosis. Anemia can cause debilitating fatigue, weakness and shortness of breath. It can also cause headaches, ringing in the ears, chest pain, changes in menstruation, and decreased sex drive. Anti-HIV treatment does not effectively treat anemia. Effective treatments include epoetin alfa (such as Procrit or Epogen) or darbepoetin alfa (Aranesp) to increase hemoglobin levels to a healthy level.
Atazanavir, an experimental, once a day protease inhibitor continues to look promising in studies. Studies indicate that the drug doesn't elevate triglycerides and cholesterol, two big issues with many other HIV drugs, although cases of elevated bilirubin levels have occurred.
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