BETA News Briefs
Latest News from the Bulletin of Experimental Treatments for AIDS
Viral "Blips" May Not Indicate Treatment Failure
Slight, intermittent increases in viral load in people using HAART do not necessarily indicate that the drugs are not working, according to two studies published in the July 11 issue of the Journal of the American Medical Association.
In the first study, Diane Havlir, M.D., and colleagues from the University of California at San Diego analyzed data from 254 HIV-positive persons taking triple combination antiretroviral therapy; 241 people were followed for a median of 84 weeks and 13 were followed for 4.5 years. Intermittent viremia was defined as an increase in viral load to over 50 copies/mL, followed by a drop back below 50 copies/mL on the subsequent test. Intermittent viremia was seen in 40% of the shorter follow-up group and just under one-half of the longer follow-up group.
In the shorter follow-up group, intermittent viral load increases did not predict eventual treatment failure; ten of 96 participants (10%) who had experienced intermittent viremia went on to experience virologic failure, compared with 20 of 145 participants (14%) who had not had viral "blips." In genetic tests of viral DNA from the longer follow-up group, viral material from seven of the 13 did not show drug-resistant mutations.
In the second study, Robert Siliciano, M.D., and colleagues from Johns Hopkins University examined blood samples from 20 HIV-positive persons (seven children and 11 adults) who had been on standard HAART including a protease inhibitor (PI) for two years or more. The researchers found that combination therapy appeared to inhibit viral mutation even in those who experienced intermittent viral load increases.
Physicians often assume that increases in viral load indicate treatment failure and should prompt a switch to different drugs. The new results suggest that this may not always be necessary.
PLA Injections for Facial Wasting
For many people with HIV, facial wasting is one of the most disturbing symptoms of lipodystrophy (altered body fat) syndrome. A presentation at the 2nd International Workshop on Adverse Drug Reactions and Lipodystrophy, held in September 2000 in Toronto, offered a new option for people with sunken cheeks and temples.
The method, developed by French plastic surgeon Patrick Amard, M.D., involves injections of polylactic acid (PLA, or New-Fill), a simple sugar, into the cheeks. In the initial analysis presented last year, 22 of 26 HIV-positive men had successful outcomes using PLA. Follow-up results at 54 weeks were presented at the European lipodystrophy workshop this past April.
According to a report by Lark Lands, Ph.D., in the June 2001 issue of POZ, PLA injections are safe and unlikely to trigger allergic reactions, and give a natural appearance. According to Dr. Amard, the injection of powdered PLA particles triggers the body to produce collagen (a skin protein); direct injections of collagen are also used for facial wasting. People typically require several sessions of injections (depending on the severity of facial wasting), spaced three or more weeks apart. Ice or lidocaine can be used to reduce injection pain, and Dr. Amard says there is no bruising or swelling after the treatment. The new and improved appearance lasts about a year and a half, after which time treatment can be repeated. PLA is currently approved in Europe and Mexico, although some U.S. physicians have received training in the procedure. For more information, see the website: www.new-fill.com.
This article was provided by San Francisco AIDS Foundation. It is a part of the publication OUTReach. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.