Have we been over medicated all along? - TheBody.com's Bulletin Boards

Big pharma is going to love this study. This is amazing to me!

By Deborah Mitchell

DENVER (Reuters Health) - It may be possible to maintain long-term suppression of HIV and prevention of immune deterioration, while significantly reducing dyslipidemia, using only nucleoside reverse transcriptase inhibitors after successful induction therapy with highly active antiretroviral therapy (HAART).

That's according to the findings of a trial presented here Monday morning at the 13th Conference on Retroviruses and Opportunistic Infections.

Dr. Guido Castelli-Gattinara of Bambino Gesu Children's Hospital in Rome and colleagues recruited 20 vertically infected children who had undetectable HIV levels after at least 2 years of HAART that included one protease inhibitor and two nucleoside reverse transcriptase inhibitors (NRTIs). After this induction therapy, all of the children were switched to maintenance treatment with zidovudine/stavudine, lamivudine and abacavir.

HAART had been started during the first months of life in seven children. Eight children had symptoms of HIV infection and six had severe immune deficiency when HAART began. HIV levels were below 50 copies/mL and CD4 T cell counts were within the normal range when the children were switched to maintenance therapy. All of the subjects underwent clinical, virological and immunological evaluation every 12 weeks.

After a mean of 108 weeks on the simplified regimen, 19 of the 20 children still had undetectable virus, normal CD4 T cell counts, normal growth patterns and good clinical parameters. The one instance of virological failure occurred in an adolescent who stopped treatment for personal reasons.

Also, eight patients exhibited viral "blips," between 50 and 1000 cells/mL, after a median of 60 weeks, but returned to undetectable viral levels. A progressive increase in specific cytotoxic T cell response was seen in about half of the patients.

Total cholesterol decreased from a mean of 187 mg/dL at baseline to 147 mg/dL after a mean of 108 weeks on the NRTI regimen. Similarly, LDL levels decreased from a mean of 113 to 82 mg/dL and triglyceride levels decreased from 91.8 to 74 mg/dL.

Based on these findings, Dr. Castelli-Gattinara's group concludes that a simplification of HAART while maintaining long-term virological and immunological control is possible. The researchers suggest that the progressive increase in cytotoxic T lymphocyte response seen in some patients may be from an increased frequency of blips or continuous viral replication in lymph nodes.

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