Benefits of Drug-Resistant HIV?
For HIV-infected individuals with drug-resistant virus, piecing together a drug regimen that can suppress the virus is a major challenge. When HIV is drug-resistant, it carries changes that allow it to reproduce in the presence of drug. However, there may be some hope for heavily treated individuals with drug-resistant virus. Research suggests that drug-resistant HIV may not always reproduce or attack T cells as well as natural or "wild-type" HIV. One report published in The New England Journal of Medicine (344:7, p. 472, 2001) indicates that patients with drug-resistant virus may benefit from staying on anti-HIV drugs -- even if their viral loads are detectable. The researchers studied a group of 23 patients who had drug-resistant virus for a year or more. Patients who stopped taking anti-HIV drugs immediately experienced increases in viral load levels and decreases in T cell counts. Those who continued taking anti-HIV drugs experienced little change in viral load or T cell count. The researchers conclude that staying on drug forces the virus to maintain drug-resistant changes, and that stopping drug allows the virus to change back to its wild type, which can do more damage.
List of AIDS-Related Cancers May Be Growing
Three forms of cancer are currently considered as AIDS-defining diseases: cervical cancer, non-Hodgkin's lymphoma and Kaposi's sarcoma (a form of skin cancer caused by a herpes-type virus). However, an analysis of more than 300,000 patients with AIDS suggests that other forms of cancer may also be caused by immune suppression. The study was conducted by researchers from the National Cancer Institute and the Danish Epidemiology Science Center using data from the "AIDS-Cancer Match Registry Study, United States, 1978-1996." The analysis, published in the April 4 issue of The Journal of the American Medical Association (285, p. 1736, 2001), shows an increased risk of Hodgkin's disease, lip cancer and testicular cancer in patients diagnosed with AIDS. Specifically, AIDS patients were 11.5 times more likely to have Hodgkin's disease, 3.1 times more likely to have lip cancer, and 1.8 times more likely to have testicular seminoma (a cancer of the testes). Although other forms of cancer also showed higher risks in AIDS patients, these cancers either were associated with risk factors independent of immune status (for example, lung cancer with "heavy smoking") or were not different before and after AIDS diagnosis. The researchers recommend that Hodgkin's disease, and possibly lip cancer and testicular cancer, be considered AIDS-defining conditions associated with advancing immune suppression.
Run, Spot, Run!
HIV-infected people who exercise regularly may be able to increase their endurance and improve their body fat composition, according to a report in the journal AIDS (15, p. 693, 2001). Past studies have shown aerobic exercise to improve patient health in chronic conditions like cancer and heart disease; this may also be true in individuals with HIV infection. Researchers from the University of Alabama at Birmingham School of Nursing studied the effects of 12 weeks of aerobic exercise in 60 HIV-infected adults. After the 12 weeks, subjects were able to stay on a treadmill longer than those who did not exercise. Although the aerobic exercise increased the maximum oxygen use in the patients, the program had little impact on breathing measurements (like shortness of breath). During their exercise program, participants lost an average of about 3.3 lbs and reduced their fat consumption from 35% to 30% of total calories. Exercise also had beneficial effects on muscle-to-fat ratio, skin fold (subcutaneous fat) measurements, and waist circumference. The exercise did not appear to have any effect on T-cell count or viral load.
New Drug Application Submitted for Tenofovir
On May 1, 2001, Gilead Sciences announced the submittal of a New Drug Application (NDA) to the US Food and Drug Administration (FDA) for approval of tenofovir disoproxil fumarate (tenofovir DF). This drug is an inhibitor of the HIV enzyme reverse transcriptase, a protein that is crucial to the reproduction of HIV. Currently approved reverse transcriptase inhibitors include nucleoside and non-nucleoside inhibitors, but tenofovir is a nucleotide reverse transcriptase inhibitor, which has slightly different chemical properties. FDA review and action is expected within 6 months. Tenofovir is dosed as a single 300mg tablet taken once daily. Side effects associated with the use of tenofovir have yet to be characterized fully. In January 2001, Gilead announced an expanded access program to provide tenofovir to people with advanced HIV infection. For more information regarding the tenofovir early access program or to request registration materials, call 800.GILEAD-5.
Anti-HIV drugs have played an important role in greatly reducing the risk of HIV transmission from mother to child (also called "vertical transmission"). However, transmission is also possible through breastfeeding, so HIV-infected mothers are warned against breastfeeding their children. Now, researchers at the University of Nairobi in Africa have identified another reason not to breastfeed -- higher risk of death for the HIV-infected mother. The researchers studied 425 HIV-positive mothers in Nairobi. Two years after delivery, HIV-positive mothers who breastfed had a death rate of 10.5% compared to 3.8% in mothers who used formula. Also, this effect extended to children, since the children of mothers who died from AIDS were eight times more likely to die than children with surviving mothers. The reasons for the increased death rate are not clear. The research is published in The Lancet (357:9269, p. 1651, 2001).
Fatigue can have many possible causes: anemia (low red blood cell counts or their ability to carry oxygen to cells), sleeping problems, poor nutrition, hormone imbalances, depression and anxiety, active infection (like HIV or hepatitis), medication side effects, etc. If you frequently feel tired or "out of energy," you may be experiencing fatigue. Talk to your health care provider about how you feel. He or she may be able to take some tests and suggest ways to overcome fatigue. An informative article on fatigue is available online in the Spring 2001 issue of the Bulletin of Experimental Treatments for AIDS (BETA). Some tips in the article for helping to cope with fatigue include:
Increased Frequency of Oral Warts
A review of the records from 1,280 patients with HIV seen at a clinic between 1990 and 1999 indicates that the frequency of oral warts is increasing, despite the use of anti-HIV therapy. While the incidence of several oral infections decreased during this period, this was not the case with oral warts. A three-fold increase in oral warts was seen in patients taking anti-HIV therapy (not including protease inhibitors) and a six-fold increase in oral warts was seen in patients taking anti-HIV therapy that included protease inhibitors. The authors could not provide an exact reason for this observation, but suggest that the rebound of the immune system caused by anti-HIV therapy may be incomplete. The report was published in The Lancet (357, p. 1411, 2001).
This article was provided by The Center for AIDS. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.