Important note: Information in this article was accurate in January 2001. The state of the art may have changed since the publication date. Report from ICAAC: The Year's Top Publications in HIV/AIDS
John G. Bartlett, M.D. The Hopkins HIV Report - January 2001
Robert Schooley presented a review of the year's top publications in the field of HIV/AIDS. His choices included the following:
Korber B, et al: Timing the ancestor of the HIV-1 pandemic strains.Science 2000 Jun 9;288(5472):1789-96. Analysis of the evolutionary tree of HIV sequences led to the estimate that it was introduced into humans in the early 1930's with a range of 1915 to 1941.
Schwartlander B, et al: AIDS in a new millennium.Science 2000 Jul 7;289(5476):64-6. This is a review of global HIV infection with an emphasis on the devastation in Africa, where nine countries have a reduction in life expectancy exceeding 20 years. In Botswana, for instance, a 15-year-old boy has an 85% risk of death from AIDS.
Carpenter CC, et al: Antiretroviral therapy in adults: Updated recommendations of the International AIDS Society-USA Panel.JAMA 2000 Jan 19;283(3):381-90. A 17-member international panel of experts provided updated recommendations for therapy with FDA-approved antiretroviral agents. These recommendations differ from the prior recommendations in that there is greater emphasis on long-term benefit, flexibility, and individual-based decisions. Nevertheless, recommendations for initial therapy continued to emphasize the central role of combination regimens that include two NRTIs plus an NNRTI or two NRTIs plus one or two PIs.
Mocroft A, et al: AIDS across Europe, 1994-98: The EuroSIDA study.Lancet 2000 Jul 22;356(9226):291-6. This is a multicenter observational study of over 7,300 HIV-infected patients in 52 European clinics. The incidence of an AIDS-defining diagnosis decreased from 30.7/100 patient-years in 1994 to 2.5/100 patient-years in 1998. The largest decrease was seen for infections involving CMV and MAC; the proportion of non-Hodgkins lymphoma as an AIDS defining condition increased from 4% to 16% in 1998 [see "HIV Associated Lymphomas"]. Dr. Schooley made the additional observation that the number of opportunistic infections at a given CD4 cell count is decreasing, which suggests that a decrease in viral load provides protection against opportunistic infections that is independent of CD4 cell count.
El-Sadr WM, et al: Discontinuation of prophylaxis for Mycobacterium avium complex disease in HIV-infected patients who have a response to antiretroviral therapy.N Engl J Med 2000 Apr 13;342(15):1085-92. This is a CPCRA/ACTG trial involving 520 participants who were randomized to continue or discontinue azithromycin prophylaxis (1,200 mg weekly) when the CD4 cell count increased from <50 to >100 cells/mm3 in response to antiretroviral therapy. During a median follow-up period of 12 months, there were no cases of MAC disease in either group. This and other similar studies have established the safety of discontinuing OI prophylaxis following immune reconstitution. Dr. Schooley also mentioned more recent data suggesting that azithromycin prophylaxis is beneficial in preventing other OIs.
Quinn TC, et al: Viral load and heterosexual transmission of human immunodeficiency virus type 1.N Engl J Med 2000 Mar 30;342(13):921-9. This is the longitudinal study of 416 HIV-discordant couples in Uganda. The major predictor of transmission was viral load. For each log increase in viral load there was a 2.5-fold increase in the probability of transmission There were no transmissions among 51 subjects with a viral load <1,500 c/mL. The probability of transmission was equal for men and women, but none of 50 circumcised male partners acquired HIV from an infected sex partner.
Guay LA, et al: Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial.Lancet 1999 Sep 4;354(9181):795-802. Pregnant women were randomly assigned to receive nevirapine (200 mg orally at onset of labor and 2 mg/kg to infants within 72 hours of birth) or AZT (600 mg orally to the mother at the onset of labor and 300 mg every three hours to delivery, and 4 mg/kg twice daily to infants for seven days). Among 626 pregnancies, the risk of HIV transmission to the infant at 14-16 weeks was 25.1% in the AZT group and 13.1% in the nevirapine group (p = 0.0006). The authors concluded that intrapartum and neonatal single-dose nevirapine reduced the rate of perinatal transmission by 47% more than AZT.
Marseille E, et al: Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa.Lancet 1999 Sep 4;354(9181):803-9. The authors examined the economic consequences of two interventions to prevent perinatal transmission, one for universal treatment of all pregnant women and the second for counseling and HIV serologic testing for targeted treatment. When seroprevalence of HIV is 30%, universal treatment would cost $138 per case prevented compared to $298 per case prevented with targeted treatment. The authors concluded that universal treatment could be justified when seroprevalence rates exceed 3%.
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Important note: Information in this article was accurate in January 2001. The state of the art may have changed since the publication date.
