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AIDS Treatment
      #41606 - 10/11/02 12:35 AM

AIDS Drugs May Cause Other Illnesses Research* Strokes and coronary disease are linked to powerful protease inhibitors, some doctors suspect.


The powerful drug cocktails that have enabled AIDS patients to live longer, healthier lives are now suspected of causing heart disease in some of the very people they've saved.

Cardiologists and AIDS specialists across the country say they are seeing an increasing number of patients on the drugs who have suddenly suffered chest pain, heart attacks, strokes or who have been found to need artery-clearing angioplasties. The problems are occurring in men in their late 30s and 40s, decades earlier than typically would be expected.

Researchers are struggling to determine whether the cardiac
complications are a consequence of the medications, the
inflammation caused by chronic HIV infection or some
combination of factors. But a few initial studies back up doctors'anecdotal reports suggesting that the drugs, specifically protease inhibitors, may be linked to the heart ailments. Researchers with the federal Centers for Disease Control and Prevention, for instance, found a slight increase in heart attacks among 3,000 HIV-positive patients on protease inhibitors, compared with 3,000 HIV-positive patients on other drug regimens.

Study author Dr. Scott D. Holmberg acknowledges that heart
attacks among AIDS patients on antiviral medications "are still relatively uncommon." But, he said, the problem is "in the early phase."

Many doctors still don't routinely screen their AIDS patients for heart disease, even though the subject of HIV and coronary artery disease has become the hot topic at many AIDS conferences.And the protease inhibitors, introduced in 1996, are relatively new.

Dr. Gary Cohan, managing director of Pacific Oaks Medical Group in Beverly Hills, one of the nation's largest private AIDS practices, agreed that the problem is still in its infancy. "We're about five years in, and we're seeing the tip of the iceberg," he said. "I think we're going to see an
epidemic of serious cardiovascular disease."

Protease inhibitors, which interfere with the production of proteins that the AIDS virus needs to reproduce, have been widely regarded as miracle drugs. And they are--giving new life to patients who thought they had no future. With some new medications, however, side effects don't show up
in clinical trials, arising only after the drugs are in much wider use.

Among the first protease inhibitor side effects to be identified was lipodystrophy, a redistribution of body fat that created the so-called buffalo hump behind the neck and big bellies in AIDS patients. And gradually doctors began to see elevated cholesterol--especially the so-called bad, or
LDL, cholesterol--triglycerides and prediabetic conditions, each of which over time can be a powerful engine for heart disease.

Although each of these conditions has been associated with other classes of drugs that attack the virus and keep it from multiplying, the elevations most often have been associated with the proteases. "The proteases are and were heroic drugs," said Cohan. But "they come with a price tag
attached that includes a lot of side effects."

The suspected link to coronary artery disease may be the most troubling, because the outcome potentially could be fatal.

Some AIDS specialists, knowing that protease inhibitors raise cholesterol and promote diabetes,have put patients on other classes of antiviral medications first, as long as the patient isn't resistant to them, and saved the proteases for later.

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Re: AIDS Treatment new
      #41639 - 10/11/02 03:32 PM

Yeah but it's a trade off. Remember that deaths are down 70% since 1993! I lived in those years and there were funerals daily in NYC! So no one said these drugs are perfect! They are not! But they can help people who have a life threatening illness and you know that's what HIV is. It's funny that just because it happens to young people--many of whom seem unwilling to be realistic and really deal with it there are these wild theories that you really don't have to take medications...that it will go away or that it is even not there! Crazy stuff. You don't hear this with diabetes! Or other diseases! You get a disease and you've got to deal with it. Plain and simple. Why there are these nuts who go around and try to confuse this I will never understand. The fact is that AIDS will kill you if you don't treat it. And the medications are getting better and better! Look at tenofovir and t-20! Their side effect profile are much better than the protease inhibitors! Also you don't have to take protease inhibitors if you don't want to. There are other choices now. This isn't a black and white issue it's much more complex!

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