(RITA!)HIV Treatment Alerts - February 2001
 

The Annual Retrovirus Conference is the major HIV scientific meeting in the United States. Each year, 3500 healthcare providers, researchers, and community activists meet for 5 days to review the latest developments in the field of HIV. You can learn more about the conference, and even hear some of the science lectures, by visiting the conference website: www.retroconference.org. The following are some reports from this year's 8^th Retrovirus Conference.

Treatment interruptions. Although it's still too soon to know whether it's a good idea, Anthony Fauci, MD, talked about a potentially exciting way to treat HIV infection. Dr. Fauci, the top federal AIDS researcher, is studying a small group of patients who take their anti-HIV drugs for 7 days, then stop for 7 days, then start again for 7 days, then . . . well, you get the picture. So far, 3 of the patients have completed 22 of these cycles and the virus has not re-emerged during the 7-day "off" periods. In other words, the viral loads stay undetectable even when the patients aren't taking meds. If this on-off approach to treatment pans out, HIV-infected people could reduce their drug intake by 50%. "This is a big deal to people; I don't think you can underestimate that," according to Fauci.

So far, so good. The rates of HIV-related cancers have so far declined along with opportunistic infections, with the exception of non-Hodgkin's lymphoma (the occurrence of which is similar to the pre-drug-cocktail era). This is good news, since many researchers had expected cancer rates to rise as HIV-infected people live longer.

D drug danger. Taking didanosine (Videx or ddI) with hydroxyurea (Hydrea) significantly increases the risk of pancreatitis, according to a study. All of the so-called "d" drugs (ddI, d4T, ddC) have the potential to cause pancreatitis, but the risk is elevated when hydroxyurea is combined with ddI.

Hepatitis C transmission and sex. An estimated one third of persons with HIV are infected also with hepatitis C virus. Assuming that the hepatitis C virus can be sexually transmitted, most clinicians believe it happens only rarely. In fact, most transmission occurs through contaminated blood and intravenous needle sharing. However, a new report shows how sexual transmission may happen. Studying a large group of gay men, Canadian investigators concluded that hepatitis C was transmitted by the practices of manual penetration (fisting) and oral-anal contact (rimming).

Pep pills. Many people with HIV complain of fatigue, and often doctors have a difficult time making it better. But physicians from New York may have a possible solution. They gave fatigued patients 60 mg a day of Ritalin, and 41% reported significant improvement in their energy level, compared to only 15% of those who took a sugar pill. Some of the Ritalin-receiving patients reported jitteriness as a side effect.

This is your virus on drugs. A San Francisco study shows that pot smoking does not increase viral load, decrease T cell count, or interfere with anti-HIV medications. In the study, volunteers were assigned to smoke pot, or take Marinol, or take a sugar pill. (Marinol is a medication derived from pot and used to help improve appetite.) At the end of the study, there were no medically important differences between the 3 groups. No word on when this trial may come to Texas, but don't hold your breath.

Resistance is futile? General media, such as The New York Times, crave AIDS stories with a dramatic edge and reports of an HIV "superbug" fit the bill. The danger of a superbug is that drug-resistant HIV might be passed from one person to another, leaving the newly infected person with little or no treatment options. In more clamoring aimed at promoting the sale of drug resistance tests, several investors-uh, investigators-hyped the spread of drug-resistant virus in the US. The occurrence of drug-resistant virus transmission has increased slightly over the last few years, but the numbers remain tiny: generally around 10% of new cases, although these numbers vary by region. And even in these cases, it's only assumed, but not proven, that people suffer any actual medical harm. It's also assumed, but not proven, that drug resistance testing helps those patients. These assumptions about the spread of drug-resistant HIV create a false alarm that some people are spreading a virus even more deadly than the original. Until this is proven, the general media should stop contributing to the hype.

Caution with garlic supplements. A study presented at the conference has shown that the use of garlic supplements can reduce levels of the protease inhibitor saquinavir (Fortovase) in the blood. Garlic supplements are usually taken to help lower cholesterol levels. The researchers measured levels of saquinavir in uninfected individuals who were also taking garlic supplements. (The active ingredient in garlic is called allicin.) Blood levels of the protease inhibitor were reduced by half, leading to the conclusion that "patients should use caution when combining garlic supplements with saquinavir." Typically, small amounts of the protease inhibitor ritonavir (Norvir) are given with saquinavir to improve blood levels of saquinavir. However, the information presented did not address this point.

HIV differences in women and men. Previous studies have shown that women infected with HIV progress differently than men. For example, some studies suggest that women, when compared to men at the same stage, generally have lower viral loads. Other studies suggest women may get sick at a lower viral load level than men. In the continuing effort to look at the disease progression of women, a study reported at the conference looked at whether menopause and pregnancy had any effect on T cell counts. This European study looked at a group of 487 HIV-infected women to try to estimate the impact of pregnancy and menopause in these women. They concluded that postmenopausal women had significantly lower T cell counts and that pregnant women had lower T cell counts during their pregnancies, but that these counts came back up after delivery. This study indicates that reproductive hormones may affect levels of T cell counts in women and that this phenomenon may explain the differences in T cell counts between men and women.

Definitions:

Pancreatitis: inflammation of the pancreas, an internal organ, usually involving pain in the upper abdomen (just under the ribs) and possible nausea and vomiting.

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Copyright © 2001 - Research Initiative Treatment Action (RITA!). Reproduced with permission. RITA! is published by The Center for AIDS. Contact Thomas Gegeny, MS, ELS, Editor, RITA! for permission to reproduce RITA!. tom@centerforaids.org. http://www.centerforaids.org

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