Report from the Adult AIDS Clinical Trials Group (AACTG) Meeting
Arlington, VA, July 12-15, 2001
Reprinted from amfAR HIV/AIDS Treatment Directory Online, www.amfar.org.
DepressionThe meetings opened with an interactive session on the study of depression. We know that depression is a significant factor in nonadherence [failure to take every dose of anti-retroviral therapy (ART)]. Dr. Glenn Treisman, Director of AIDS Psychiatry Services at Johns Hopkins University School of Medicine, said that depression could result from diseases of the brain or from adverse situations. People living with HIV (PLWH), he said, are often depressed due to disease, such as neurochemical defects, limbic system impairments, post-partum depression, or schizophrenia. Depression is associated with insomnia, chronic pain, prior episodes of depression, and a family history of depression. Depression responds well to medication. Dr. Treisman also said that 20% of PLWH are demoralized -- often due to grief, and respond well with time, support, and socialization. Symptoms of depression include sadness, loss of pleasure, suicidal thoughts, and pessimism.
Judith Neidig, R.N., Ph.D. of Ohio State University, reported that depression also carries with it, in addition to the risk of non-adherence, risk of withdrawal from clinical trials, poorer health outcomes, and high-risk sexual behaviors.
Women's Health Committee MeetingsThe moderators of this session were Drs. Susan Cohn of the University of Rochester Medical Center Infectious Diseases Unit and Jane Hitti, Assistant Professor of Obstetrics and Gynecology at the University of Washington Medical Center.
About 30% of the U.S. HIV+ population are women -- 54% identify as Caucasian, 23% as African American, 20% as Hispanic/Latina, 1% as Asian, 1% as Native American, and <1% as "other."
It was reported in the Women's Health Committee/Pharmacology Committee Interactive Session, that menstrual cycle does not appear to affect drug absorption. However, menstrual cycle may affect the metabolism of drugs, although probably by no more than 15%.
No pharmacokinetic differences between women and men have been observed with the nucleoside analogs, although abacavir, the newest drug in this class, has not been thoroughly studied yet.
Women may also be receiving larger doses of non-nucleoside reverse transcriptase inhibitors (NNRTIs) than men -- possibly due to weight differences.
Finally, no significant gender differences have been seen with the pharmacokinetics of protease inhibitors (PIs).
Later That Same Day . . .In the Women's Health Committee business meeting, Alan Landay, Ph.D. of the Department of Immunology/Microbiology at Rush-Presbyterian-St. Luke's Medical Center proposed to study factors that modify the female genital tract environment and influence its role as a portal of entry for HIV. He thinks a couple of these factors may include bacterial vaginosis, and an entity he calls "HIV Inducing Factor," which seems to be sensitive to PIs and may be associated with Epstein-Barr virus.
Dr. Robert Coombs, Associate Professor, Division of Virology at University of Washington, Seattle, hypothesized that female genital tract inflammation increases HIV activation and replication. The genital tract, he said, is a sanctuary separate from the bloodstream with possibly different viral populations and varying degrees of drug penetration.
Remarkably, human papilloma virus (HPV) and the associated changes in cervical and anal cytology -- including cancer, were not mentioned at this meeting.
Dr. Anthony Fauci of NIAID finally said out loud what I've been wanting acknowledged for a long time: We are aiming for long-term control of HIV rather than eradication.
Dr. David Katzenstein, of Stanford University Medical Center (having recently witnessed a solar eclipse) closed by drawing a beautiful analogy of our hopes for research: ". . . to experience darkness at noon and have it go away."
This article was provided by Gay Men's Health Crisis. It is a part of the publication GMHC Treatment Issues. Visit GMHC's website to find out more about their activities, publications and services.