Table of Contents: CATIE TreatmentUpdate - 2001


Canadian AIDS Treatment Information Exchange
Edited by: Sean Hosein

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TreatmentUpdate 123: November/December - Vol. 13, No. 7

English  Françaises
 Trizivir approved in Canada

 Trizivir est approuvé au Canada

HoseinSR
On 17 October 2001, Health Canada approved the sale of Trizivir tablets in Canada. Trizivir was approved for the treatment of adults with HIV/AIDS, at a dose of one tablet twice daily, with or without food.

 Caution with nelfinavir and some lipid-lowering drugs

 Un avertissement au sujet du nelfinavir et de certains agents hypolipidémiants

HoseinSR
Protease inhibitors (PIs) are often used as part of combination therapy for people with HIV/AIDS (PHAs).

 Lipodystrophy - introduction

 Lipodystrophie – introduction

HoseinSR
The use of highly active antirretroviral therapy (HAART) has helped to reduce complications from AIDS in North America and Western Europe. Unfortunately, however, HAART-users can experience a range of side effects, including the following — which collectively is called the lipodystrophy syndrome.

 Glucose — from food to blood sugar

 Glucose – rapport sur les aliments et le sucre sanguin

HoseinSR
Because cells are very dependent on glucose for energy, the body tries to maintain blood sugar levels within a normal range using the hormone insulin. When we don't eat enough food, the liver and kidneys try to maintain blood sugar levels by breaking down stored starch or protein and converting them into glucose.

 Sugar blues and protease inhibitors

 Problèmes de sucre et inhibiteurs de la protéase

HoseinSR
As previously mentioned, protease inhibitors (PIs) can increase the risk of type 2 diabetes. Here are some findings from several reasearch teams. Readers should note that although some of this work focuses on the PI indinavir, it is likely that all PIs have similar effects.

 Metformin — long-term results

 Metformine – résultats à long terme

HoseinSR
Results from a placebo-controlled study of metformin showed that this drug clearly helped insulin resistance and decreased weight and blood pressure in HIV positive subjects experiencing lipodystrophy.

 Focus on fat

 Le point sur le gras

HoseinSR
In the lipodystrophy syndrome, strange changes in the distribution of fat occur. For instance, it is not uncommon for fat in the face, arms and legs to disappear while fat in the breast and stomach increase. As well, levels of fatty substances — cholesterol and triglycerides — tend to increase, particularly in PHAs who use HAART.

 Actos (pioglitazone)

 Actos (pioglitazone)

HoseinSR
For their study of the glitazone Actos (pioglitazone), researchers in Geneva recruited nine HIV positive subjects who were using HAART. That all subjects were taking anti-HIV drugs is important because Actos is processed in the liver by the same enzyme that helps break down protease inhibitors and non-nukes. This enzyme is called p450 3A4. Researchers gave Actos at a dose of 30 to 45 mg/day for six months.

 Rosiglitazone for lipodstrophy?

 Rosiglitazone contre la lipodystrophie?

HoseinSR
Another drug that is part of the glitazone group is rosiglitazone (Avandia). This drug also helps to make cells more sensitive to insulin and thus reduces high blood sugar levels. Doctors are prescribing this drug for their patients, hoping that Avandia will help prevent or reduce signs/symptoms of lipodystrophy.

 Toxicity profile of HAART

 Profil de toxicité des multithérapies antirétrovirales

HoseinSR
Because there is no combination of anti-HIV drugs that is best for everyone, therapy has to be tailored to the needs of each person. Decisions about choosing therapies are usually based on individual factors such as CD4+ cell count, viral load and the presence of symptoms of HIV/AIDS. Other factors, such as the ability to meet food, water and strict schedule requirements of certain regimens and the ability to endure certain side effects, likely play a role as well. Another point to bear in mind is that in the real world reports of side effects are usually greater than those that are received during clinical trials.

 Hepatitis C treatment, HAART and side effects

 Traitement contre l'hépatite C, multithérapie et effets secondaires

HoseinSR
Increasingly, doctors are using the new, long-lasting form of interferon alpha called peg-interferon (sold under the brand names Pegasys or Peg-Intron) and the drug ribavirin (Virazole) to treat hepatitis C virus (HCV) infection. Sometimes this therapy is given to PHAs who are also using HAART. It is important to note that most HAART regimens contain nukes — AZT, ddI, 3TC and similar drugs — and that the toxicity from nukes is thought to underlie many of the problems seen in the lipodystrophy syndrome. This point is noteworthy because a key part of HCV treatment is the use of the anti-HCV nuke ribavirin (Virazole, Virazid). Therefore, some doctors are concerned that use of ribavirin may intensify certain aspects of the lipodystrophy syndrome, such as fat wasting.

 Can delavirdine substitute for ritonavir?

 La delavirdine peut-elle remplacer le ritonavir?

HoseinSR
The protease inhibitor (PI) ritonavir (Norvir) is often used together with another protease inhibitor such as amprenavir (Agenerase), indinavir (Crixivan) or saquinavir (Fortovase) because ritonavir can boost the level of these other PIs to a higher level than they would ever reach if they were taken without ritonavir. A ritonavir-boosted regimen often has the advantage of better anti-HIV activity than a single-PI regimen. Boosted regimens also allow PHAs to take their pills twice daily rather than three times daily. Another advantage of boosted regimens is that they often involve fewer pills than do unboosted regimens.

Table Of Contents

TreatmentUpdate 123: November/December - Vol. 13, No. 7
Can delavirdine substitute for ritonavir?; Hepatitis C treatment, HAART and side effects; Toxicity profile of HAART; Rosiglitazone for lipodstrophy?; Actos (pioglitazone); Focus on fat; Metformin — long-term results; Sugar blues and protease inhibitors; Glucose — from food to blood sugar; Lipodystrophy - introduction; Caution with nelfinavir and some lipid-lowering drugs; Trizivir approved in Canada;

TreatmentUpdate 122: October - Vol. 13, No. 6
Looking at soluble CD23 levels to predict lymphoma; Cidofovir for KS lesions; Can low-dose shark cartilage make Kaposi's sarcoma disappear?; Chemo and HAART extend survival with lymphoma; Encouraging news on lymphoma from France; AIDS and lymphoma; New formulation of ddI approved in Canada — Videx EC; Expanded access to tenofovir

TreatmentUpdate 121: September - Vol. 13, No. 5
SIDE EFFECTS - Andractim for HAART-associated breast enlargement; SIDE EFFECTS - Does efavirenz cause breast enlargement?; IMMUNE BOOSTERS - Interleukin-12 may be useful for hepatitis C; ANTI-HIV AGENTS - Study finds HIV subtly damages vision; ANTI-HIV AGENTS - Searching for the right dose of ritonavir-saquinavir; ANTI-HIV AGENTS - Different combinations of ritonavir-indinavir

TreatmentUpdate 120: August - Vol. 13, No. 4
Depression linked to immune system decline in women; Carnitine for high triglycerides; Lipid-lowering drugs and changes to diet can make a difference; Sexual dysfunction and HAART; Immune booster used to fight drug-resistant herpes; Effect of HAART on cervical growths; Switching to nevirapine — results after one year

TreatmentUpdate 119: July - Vol. 13, No. 3
Fosamax for HIV-related bone problems?; Indinavir and bones: Does thickness = strength?; Lipodystrophy — nukes vs. protease inhibitors; Spanish study looks at nevirapine's effect on the liver; Pesticides found in many ginseng supplements in the U.S.; Can ginseng help suppress HIV?; Large Italian study looks at when to start HAART;

TreatmentUpdate 118: June - Vol. 13, No. 2
Protease inhibitors and blood sugar problems; Indinavir - effect on sugar and insulin; Background on glucose — from food to blood sugar; Extra co-enzyme Q10 for statin-users?; Can vitamin E help people recover from hepatitis B?; Study examines link between low levels of zinc and survival; Zinc and the immune system;

TreatmentUpdate 117: May - Vol. 13, No. 1
Bone damage - more than just nukes involved; Australian study links nukes, lactic acid to bone loss;High levels of lactic acid in some users of HAART ;Nukes may be linked to hearing loss; Of power plants and energy shortages; German study finds whey protein supplement boosts antioxidants; Spanish doctors try switching therapy from month to month

TreatmentUpdate 115: February - Vol. 12, No. 11
St. John's wort found to lower nevirapine levels; Are deaths due to liver damage becoming more common?; St. John's wort extract found not helpful for hepatitis C; Canadian researchers study "immune healing"; Kaletra approved in Canada;

TreatmentUpdate 114: January - Vol. 12, No. 10
Some women may be at high risk for anal cancer; DHEA — Cautions and concerns; DHEA for depression?; Changes in DHEA levels in people taking anti-HIV therapy; DHEA — Background; Nukes linked to fat wasting; Triple nuke therapy — results after one year; Switching meds: from protease inhibitors to non-nukes

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