Findings from a new study are likely to change the clinician's approach to HIV management over the course of the next year. The new study looked at rates of change in viral load and found that the rate of decline of a patient's HIV after the first six days of treatment is a good predictor of the patient's long-term response to treatment. Current guidelines indicate that providers should change a patient's treatment if the reduction in plasma HIV RNA is less than 0.50-0.70 log after four weeks of treatment or less than 1.00 log by eight weeks of therapy. This study has shown that much earlier predictions of treatment efficacy are possible. Critics warn that predicting treatment efficacy after six days of treatment is only valid if more is known about the patient's adherence to the drug regimen. (Lancet 2001; 358 (9295): 1760-1765)
A new study from the National Institutes of Allergy and Infectious Diseases shows that cycling antiretroviral medications in a seven-day-on, seven-day-off manner appears to reduce toxic side effects without reducing the drug's effectiveness. The study put 10 patients on a "structured intermittent therapy" regimen where they received combination therapy of stavudine, lamivudine, indinavir, and ritonavir for seven days followed by seven days of no medication before beginning the next drug cycle. All of the participants maintained their CD4+ count and viral load levels throughout the 32-68 week study. While there were no signs of drug resistance in these patients, there were marked decreases in serum cholesterol and triglyceride levels. Larger scale trials are now underway. If these trials support the small-scale study and prove that there are no adverse effects, drug costs could be reduced by as much as 50%. Results from this study are expected to be released in February, at the annual Retrovirus conference. Practitioners and patients are advised to await definitive data before adopting this approach to HIV treatment. (NIH Release, 12/3/01)
Following the approval of the Los Angeles County Sheriff's Department, the Los Angeles County Jail (LACJ) has begun distributing condoms to its "self-declared" gay inmates. In the LACJ, gay inmates are segregated into separate housing units. Inmates are receiving condoms through an outside agency, which provides a weekly HIV/AIDS lecture and then distributes the condoms. Margaret Winter of the American Civil Liberties Union (ACLU) has said that the provision of condoms to self-declared gay men does nothing to protect the large numbers of men who participate in sex in prison but do not self-identify as gay. Although having sex while incarcerated is a felony under California law, the sheriff's office has recognized the rising number of new HIV cases in the jail and is responding to the health crisis. The LACJ is the seventh correctional facility on the nation to begin distributing condoms, joining four other jails in New York City, Philadelphia, San Francisco and Washington, and two prisons, in Vermont and Mississippi. (LA Times, 11/30/01)
Continuing the recent trend in HIV management studies, two separate studies appear to demonstrate that delaying HAART until a patient's CD4+ count drops to 200 cells/mL and has a high level of virus circulating in the bloodstream is safe. Although it took longer for patients with higher initial viral load levels to reach an undetectable level of virus, all patients had the same chance of having an undetectable viral load after 32 weeks of treatment. Furthermore, patients whose CD4+ count was between 200 and 349 at baseline fared just as well after 32 weeks of treatment as patients whose initial levels were higher than 350. While these findings have the potential to change treatment recommendations, experts caution that these results may not be the same for all patients, especially women, who exhibit different viral loads and may develop full-blown AIDS at lower levels of viremia than men. (JAMA 2001; 286 (20): 2560-2567 and 2568-2577)
A new study conducted by researchers from Columbia University notes that HIV-positive women are at increased risk for vulvar cancer as well as cervical cancer. A study group of 925 women was followed for 3 years. Women underwent twice-yearly gynecological examinations. At the start of the study, 6% of the 481 HIV-positive women had vulvovaginal/perianal condoloma acuminata or intraepithelial neoplasia compared to only 1% of the HIV-negative women. Throughout the course of the study, HIV-positive women who did not previously have vulvar cancer were 16 times more likely to develop vulvo-vaginal or perianal lesions compared with the HIV-negative women. Risk factors for developing lesions included HIV infection, decreased CD4+ count, HPV infection, and a history of frequent injection drug use. (Lancet 2002; 359:108-113)
This article was provided by Brown Medical School. It is a part of the publication HEPP News.