Canadian HIV Study Attempts to Salvage Lost Lives

Ottawa researchers are developing a major study of ways to "salvage" the lives of HIV-positive patients who are facing decreased drug options due to the failure of their antiretroviral medications. The drugs that have saved thousands of lives are now failing a growing number of patients.

Ottawa Hospital will be the lead Canadian site for an international study designed to find the "salvage therapy" for patients with HIV/AIDS whose bodies are no longer responding to standard treatment. The Optima study will involve about 80 centers across Canada, the United States and the United Kingdom.

Dr. Bill Cameron of Ottawa Hospital's department of infectious diseases and the lead Canadian researcher for the trial said the study "will address a pressing need for patients who have used, and lost, their treatment options."

"Things have changed so much that, in 1990, having HIV infection was a death sentence. In the year 2001, having HIV is a life sentence -- in terms of medications. If you and your doctor can sort out the medication that will be most agreeable in terms of tolerance and safety, as long as you take those pills like a robot, you can expect to live out your natural life," provided there are no serious long-term complications, Cameron said.

But for up to 40 percent of patients, the drugs fail within a year of starting treatment. In some cases, the drugs fail to suppress the virus for more than a few months. Some patients can't follow the rigid dosing regimen. Some patients can't tolerate the serious side effects. In these cases, important questions emerge, according to Cameron. "What do we do now?" "Would it be better to stop treatment for three months, take a break. . . then restart after three or four months off pills?"

The Optima trial will test two strategies: One will compare a drug holiday with uninterrupted treatment. Another salvage strategy will compare "treatment intensification" -- using multiple antiretrovirals -- compared to "your best choice of standard therapy," Cameron said.

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