The Body Covers: The 2nd International AIDS Society Conference on HIV Pathogenesis and Treatment
What were the top developments from IAS 2003? Judith Aberg, M.D., Cal Cohen, M.D., Robert Frascino, M.D., and Paul Sax, M.D., offer their opinions.
There may remain a small subset of patients for whom a three-NRTI regimen is appropriate, but given the high rates of failure relative to the efavirenz-containing arms of ACTG 5095, clinicians should think long and hard before using Trizivir or any other triple nucleoside combination alone. Brian Boyle, M.D., reports from IAS 2003.
The durability of T-20's benefit combined with its optimized background is similar to that of other effective salvage regimens. Read Andy Pavia, M.D.'s review.
Gerald Pierone, Jr., M.D., discusses the pros and cons of structured treatment interruptions in his coverage from IAS 2003.
"Probably the most controversial finding of the FRAM study is the lack of an association between lipoatrophy and central fat gain." Timothy Wilkin, M.D., reports from IAS 2003.
Any strategy that can reduce one's time on antiretroviral therapy and save money will lead to more people having access to these life-saving medications. One strategy still being researched is the use of therapeutic vaccines. Timothy Wilkin, M.D., provides an update from IAS 2003.
In a review of nevirapine and efavirenz-containing regimens, researchers found both to be very effective and well tolerated. Within a reasonable degree of certainty, they are equally potent out to one year. However, while efavirenz has great data showing that this potency persists, similar studies for nevirapine have just not been done yet. Andrew T. Pavia, M.D., reports from IAS 2003.
Cal Cohen, M.D., reports on the most recent results from the pivotal trial of tenofovir + 3TC + efavirenz vs. d4T + 3TC + efavirenz. He writes: "the tenofovir arm has been influential in establishing an attractive outcome not just for response rates, but for safety as well, since the tenofovir arm had few side effects, and a notably low rate of lipodystrophy, as seen at week 96."
Based on the metabolic changes we are seeing now we can justifiably predict higher rates of vascular complications in the future. This means that prevention efforts as well as strategies for early diagnosis and treatment should be put into place now. Gerald Pierone, Jr., M.D., reports from IAS 2003.
"These study results were a topic of discussion for many since all previous studies of atazanavir were done with it as an unboosted drug, and no one had anticipated its effectiveness being similar to Kaletra as a result of boosting." Cal Cohen, M.D., reports from IAS 2003.
Results at 96 weeks show tenofovir (Viread) still the winner against d4T (stavudine, Zerit) in the side effect gamble -- especially in regards to mitochondrial problems like peripheral neuropathy, lipodystrophy and lactic acidosis. Paul E. Sax, M.D., reports.
Evidence mounts regarding antiretroviral therapy-associated cardiovascular complications with protease inhibitor therapy associated with lipid abnormalities and a trend for increased risk of cardiac events. Gerald Pierone, Jr., M.D., reports from IAS 2003.
Rosiglitazone may be effective in increasing body fat in patients with fat wasting. Mark Holodniy, M.D., reports from IAS 2003.
Abacavir/3TC/tenofovir combination a failure in treatment-naive patients -- 58 percent experienced virologic failure by week eight. Timothy Wilkin, M.D., reports from IAS 2003.
In a study in Kenya, a significant association was found between oral contraceptive use and acquisition of HIV, a rate 1.5 times that of women using no contraception or surgical sterilization.
The newest antiretroviral on the block, emtricitabine (FTC, Emtriva), looks good in comparison to d4T (stavudine, Zerit) when either is taken in combination with both ddI (didanosine, Videx) and efavirenz (Sustiva). However, more comparisons are needed to really show the strengths and weaknesses of this newly approved medication, reports Paul Sax, M.D.
Lipoatrophy has been associated with many HIV medications. In this study significant improvement was seen in subcutaneous fat, as well as self-reported improvements in lipoatrophy, when either AZT or abacavir was substituted for d4T in patients with lipoatrophy or elevated lactate or both. Paul Sax, M.D., reports from IAS 2003.
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