Protease inhibitors (PIs) have been linked to certain side effects including the development of high levels of lipids (triglycerides and cholesterol) in the blood. Switching patients to a non-nucleoside based drug regimen (using Nevirapine or Efavirenz) has been a common strategy used by physicians to counter this problem. However, Swiss researchers have recently found that 38% of patients continued to have high cholesterol levels once their medication was switched. When the patient was originally taking the PI ritonavir, the switch to efavirenz was more likely to decrease the triglyceride levels. Patients originally on other PIs who switched to efavirenz had little or no change in lipid levels. Authors suggest clinicians should keep this in mind when considering changes in a patient's regimen. In another study released this week, Viramune (nevirapine) did seem to be associated with lower lipid levels. HIV care providers should be aware that the "jury is still out" on the effect of NNRTIs vs PIs on lipid levels. (J AIDS 2001; 26 (4): 389-391)
Physicians in Pima County, Arizona are beginning to see an increase in AIDS-related deaths for the first time since the advent of HAART in 1995; the number of AIDS-related deaths this year is expected to double. Washington State is also seeing an increase in AIDS cases for the year 2000, the first increase in nine years. The percentage of women and minorities with AIDS is also increasing. These increases may be attributable to lack of access to treatment and the beginning of failure of the triple-drug cocktail which has become the standard regimen for HIV infection. Health officials in the United Kingdom are seeing a similar phenomenon, with as many as 25% to 27% of HIV patients exhibiting resistance to one or more antiretroviral drugs. The risk of infection by drug-resistant HIV strains has increased yearly through the 1990s. "Super HAART" regimens, consisting of four or more drugs, is being used in patients for whom the existing triple-cocktail therapy has failed. (Reuters, 5/3/01)
Non-injection drug users are at higher risk for contracting HCV than members of the general population, according to a National Institutes of Health release. The findings of a new study report that 14% of non-injection drug using women and 17% of non-injection drug using men tested positive for HCV. This is significantly higher than the 2% prevalence rate of HCV among members of the general population. Sharing of contaminated syringes in injection drug use accounts for 60% of HCV infections. Researchers plan to look further into the modes of HCV transmission to determine the risks associated with non-injection drug use. (NIH press release, 5/7/01)
Although HAART has decreased HIV-related mortality, end-stage liver disease is increasing in importance as a co-morbidity factor. One study has shown that the percentage of deaths of HIV-positive patients increased from 11.5% in 1991 to 50% in 1998-1999. Most of these patients had detectable antibodies to hepatitis C virus (HCV). End-stage liver disease is now the leading cause of death among HIV-positive patients in the hospital where this study was conducted. (Clinical Infectious Diseases 32 (3): 492, 2/1/01)
This article was provided by Brown Medical School. It is a part of the publication HEPP News.