2000

PI Perspective

PI Perspective 31 -- October 2000

Durban - Between the Lines: This year's XIIIth International AIDS Conference in Durban, South Africa was not the typical AIDS conference. Because of the pressing social needs faced by developing nations, the emphasis of the meeting was not primarily directed toward biomedical research and studies.
Anti-HIV Drugs Update: Several studies of abacavir (Ziagen) were presented at the recent International Conference on AIDS in Durban. Most of the results are preliminary and are based only on interim analysis, but they do extend our knowledge of the use of the drug. They suggest that short-term use of a three-drug combination containing abacavir may be as effective as a three-drug combination including a protease inhibitor.
New Developments in STIs and SIT: As more and more researchers have come to acknowledge that current treatments are incapable of eradicating HIV, growing attention has been focused on structured treatment interruptions (STIs) and structured intermittent therapy (SIT). New strategies will apparently be required to deal with issues around long-term use of anti-HIV therapies, including side effects, adherence, treatment fatigue and the lifetime costs of the anti-HIV drugs.
Nevirapine, Prednisone and Rash: Findings from a recent study show that people taking prednisone with nevirapine (Viramune) were more likely to develop nevirapine-related rash compared to people not taking prednisone. Prednisone is commonly used to treat rash, a potentially harmful side effect of nevirapine.
Women at Durban: Globally, women and girls comprise the growing majority of people living with HIV. Reflecting this shift in the epidemic was an increased focus on women's issues at the 13th International Conference on AIDS. In all of its sessions, the conference grappled with many of the issues facing women and girls living with, and at risk for, HIV.
Medical Marijuana - Is it Safe?: Many people have used medical marijuana to manage symptoms of HIV infection and side effects of therapies. Medical marijuana users assert that the drug is useful in treating nausea, increasing appetite or as a mild analgesic (to help with headaches or mild pain).

PI Perspective 30 -- August 2000

Denial Defeated, Hope Reigns: The 13th International Conference on AIDS, held in Durban, South Africa, proved to be both the most important and the most unusual meeting since the earliest days of AIDS. This is the first time that the huge international meeting has been held in the heart of the global epidemic.
Anti-HIV Drug Update: There continues to be progress in the development of a number of new anti-HIV drugs. Additional research has focused on optimizing the use of protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs). This has resulted in studies of dual protease inhibitor combinations, protease inhibitor and NNRTI combinations and now dual NNRTI combinations.
The Latest on Structured Treatment Interruptions: Interest in structured treatment interruptions (STIs) (sometimes mistakenly called drug holidays) continues to increase. Though research in this area is relatively new and so far inconclusive, many people are already taking unplanned or unstructured treatment interruptions due to problems with drug side effects, treatment failure and adherence problems.
"Switch" Studies for People with Lipodystrophy: The major points from "Switch" Studies: Switching to a regimen without protease inhibitors may lower elevated cholesterol and triglyceride levels.; Switching may or may not effect fat redistribution; Switching doesn't necessarily lead to a loss of viral control.
Bone Problems: here are a growing number of reports of bone problems (avascular necrosis and osteonecrosis) among people with HIV. These problems are caused by a lack of blood supply in the bone, which leads to the deterioration and death of bone tissue. Generally, bones try to repair themselves.
Meeting Explores Gender Differences in Viral Load: On January 29, 2000, Project Inform co-sponsored a meeting with the National Institute of Health's Office of AIDS Research and the National Institute of Child Health and Human Development on the issue of gender differences in HIV levels. The meeting convened HIV researchers, physicians and women living with HIV to review the research to date, identify potential gaps and develop a research agenda.
Drug Pricing, AIDS and the Developing Nations: As world attention shifts to the problem of AIDS in Africa and other developing nations, it is clear that we need something other than "business as usual" if HIV-infected people are ever going to have access to treatment. The North American and European model, which relies on annual expenditures of ten to twenty thousand dollars a year per person for drugs and support services, will never meet the needs of countries that spend only a few dollars per person annually on health care.
Managing Diarrhea: Two recent studies show that using supplements is helpful in treating diarrhea associated with the use of nelfinavir (Viracept), the most common side effect of this protease inhibitor.
Herbs, Supplements and HIV: Vitamins, supplements and herbs have long been used by people with HIV in hopes of helping manage side effects of other therapies and/or improve overall general health. In fact, studies suggest that upwards of 70% of people living with HIV and about 50% of the general population use some form of complementary therapy, with the most common being approaches such as massage and acupuncture.
New Advances in Hepatitis C Therapy: There is encouraging news for people with hepatitis C virus (HCV). A new form of interferon-alfa, known as peg-interferon (PEG-Intron from Schering Plough), shows better activity than the current version of the drug.
Advances in Treating CMV: Long-awaited results from a study of treating CMV (cytomegalovirus) retinitis show that a new formulation of oral (by mouth) ganciclovir, known as valganciclovir, is as effective as the intravenous (IV, injection into the vein) version of the drug.
Immune Therapy: In Brief: A number of very small studies of immune-based therapies have reported data. The most that can be concluded on the basis of small studies is whether or not a therapy is safe and if it warrants further study. It may be years before large studies of these types of approaches are launched.
Striking a Balance: HIV Testing for Pregnant Women and Newborns: We have learned a lot about how to prevent HIV transmission from a mother to child during pregnancy, birth and infancy (sometimes called vertical transmission). Improved preventive care and voluntary HIV testing have drastically reduced vertical transmission rates in developed countries.

PI Perspective 29 -- April 2000

Millennial Heresy: Beginning in 1996, protease inhibitors and three-drug combination therapy revolutionized HIV treatment. At least in the developed world, a new highly aggressive treatment standard emerged almost overnight. Not surprisingly, four years of experience with the new therapies have shown a few cracks in that standard and it may be time to reconsider some of the common beliefs about therapy.
ddI, d4T and Hydroxyurea Side Effect Warning!: The FDA recently issued a warning that when using ddI (didanosine, Videx), some people may develop pancreatitis (a potentially life-threatening inflammation of the pancreas). An early symptom includes severe abdominal pain, which should be carefully diagnosed. Adding d4T (stavudine, Zerit) and/or hydroxyurea (Hydrea, Droxia) to ddI may further increase the risk of pancreatitis.
Nelfinavir Potency Concerns: Results from several recent studies may help clarify how to best use anti-HIV drugs as part of first line therapy. These results seem to suggest that nelfinavir (Viracept), the most widely used protease inhibitor, may not be as potent as other drugs in its class or some of the non-nucleoside RT inhibitors (NNRTIs). This article provides an overview of the studies.
Anti-HIV Drug Update: Slow but steady progress continues on a number of new anti-HIV drugs in the three drug classes. If approved, some of these represent true second-generation therapies that will offer some degree of advance over current drugs.
Manufacturer Ends Adefovir Development: Gilead Sciences has stopped development of its drug, adefovir, for use against HIV infection. This news came after the Food and Drug Administration (FDA) informed Gilead that adefovir would not be approved based on existing data and that additional studies would be necessary if it wants the FDA to reconsider the matter.
NIH Study Cautions Use of St. Johns Wort with Anti-HIV Drugs: A study conducted by the National Institutes of Health (NIH) found a significant interaction between the popular herbal therapy, St John's Wort (Hypericum perforatum), and the protease inhibitor, indinavir (Crixivan).
New Drugs in Development: In the last issue of PI Perspective (#28), we reviewed some new anti-HIV drugs in development. Since then, setbacks have occurred that will delay, and in some cases stop, the development of some of these therapies. However, other therapies show promising activity and continue through the development process quickly.
Mitochondrial Toxicity and Lactic Acidosis: Mitochondrial toxicity and one of its symptoms called lactic acidosis have been highlighted recently as a previously undiagnosed side effect of anti-HIV drugs. Some researchers believe that mitochondrial toxicity contributes to the fat redistribution (lipodystrophy) associated with anti-HIV therapy.
Resistance Testing Comes of Age: The Antiviral Drugs Advisory Committee (ADAC) to the Food and Drug Administration (FDA) recently held a two-day meeting to discuss HIV drug resistance testing. The discussion centered on currently available results from drug resistance tests and not on any one specific test or drug.
What Are Genotypic and Phenotypic Tests?: Genotypic testing looks for the presence of changes in HIV's genetic structure that are commonly associated with the development of drug resistance. When present, these changes, called mutations, alter the way the virus makes key proteins (like reverse transcriptase and protease) and often cause resistance to specific drugs.
New Information on Opportunistic Infections and Co-Infections: Many reports have shown fewer opportunistic infections (OIs) and deaths since the wide-scale availability and use of potent anti-HIV therapy. Also, there have been many reports of people stopping preventive therapies for OIs. Now several studies further confirm that it may be safe for some people to stop preventive therapies when their CD4+ cell count increases are sustained over time.
Treating and Preventing Fungal Infections Naturally: There is a strong connection between what you eat and the health of your immune system. Nevertheless, nutritional approaches to prevent and treat conditions like candidiasis (fungal, yeast infections) are complicated and controversial.
Candidiasis Update: Sustained CD4+ cell count increases as a result of potent anti-HIV therapy have been credited with a steep drop in many HIV-related conditions. Indeed, the most recent guidelines for preventing opportunistic infections (OIs) reflect the growing practice of stopping preventive and maintenance therapies.
Candidiasis Prevention Tips: Maintain good oral health: brush teeth daily, gargle with antiseptic mouthwash (like Listerine) and floss.
Organ Transplant Study Moves Forward: As HIV-positive people live longer, fewer are dying from infections usually associated with AIDS. Instead, a rise in a variety of other complications, including organ failure, are beginning to threaten the lives of people with HIV.
1999 National Conference on Women and HIV/AIDS: The 1999 National Conference on Women and HIV/AIDS, held last October in Los Angeles, convened its largest number of participants. Over 2,000 researchers, clinicians, policymakers, AIDS activists and HIV-positive women came to discuss new treatment, behavioral and political issues affecting women.
Summary of the Eighth Immune Restoration Think Tank: Project Inform hosted the eighth meeting of the Immune Restoration Think Tank: The Dobson Project (IRTT), October 8-10, 1999 in Chicago. Researchers from around the world, in partnership with community activists, convened to review data from ongoing projects, previously inspired through the Think Tank effort, and discuss new strategies and areas of focus for immune reconstitution research in people with advanced stage AIDS.
Thinking About Immune-Based Therapy ...?: In HIV disease, even though the immune system generally weakens over time, it is also in some ways over-boosted. When it comes to the immune system, "more" is not always better. For example, a whole range of diseases are called "autoimmune" illnesses in which the immune system is overactive and attacks the body itself.
Immune-Based Therapies In Brief: Immune-based therapy is considered by many to be the "holy grail" of AIDS research. Most successful therapies to date have been anti-HIV drugs that suppress reproduction of HIV, the virus that causes AIDS.
Post Exposure Prevention: There has been growing interest in the use of Post Exposure Prevention (PEP) as a means of preventing HIV infection. PEP involves a person beginning anti-HIV therapy within hours of suspected HIV exposure, with a goal of blocking the establishment of HIV infection.
The Global Crisis: AIDS in Tanzania: More than 90% of people living with HIV/AIDS are in the developing world, most of whom live in Africa, followed by Asia and Latin America. In an effort to increase awareness of the HIV epidemic in these regions, PI Perspective will feature short profiles of the epidemic in some of these countries.
Global Strategies for Mother-to-Child HIV Transmission Prevention: Women and children account for over half of those living with HIV throughout the world. Despite the growing list of HIV prevention methods (condoms, needle exchange, treatment of sexually transmitted diseases, use of maternal anti-HIV therapy, elective C-section, etc.), the number of HIV-infected women and children continues to rise dramatically.

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