Highlights from the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy
More than 12,000 physicians, clinical investigators, nurses, and other healthcare professionals from around the world met in New Orleans, Louisiana at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy to hear about the latest advances in the prevention, treatment, and control of infectious diseases. Although this conference ran right on the heels of the recent International AIDS Conference, there was further new and hopeful information reported with regard to HIV/AIDS. Listed below are some of the clinically valuable highlights.
Ritonavir-Saquinavir Combo Continues to be Impressive
The combination of the two protease inhibitors ritonavir (Norvir, Abbott) and saguinavir (Invirase, Hoffman LaRoche), earlier shown at the 11th International Conference on AIDS to produce a rapid and profound suppression of virus particles in previously treated HIV-infected patients at six weeks, now has been demonstrated to cause an even greater reduction in the viral load at 12 weeks, according to Dr. Calvin J. Cohen, an investigator at the Community Research Initiative, New England (CRINE), Brookline, Massachusetts.
In the first two treatment arms -- either ritonavir 400 mg twice daily plus saquinavir 400 mg twice daily or ritonavir 600 mg twice daily plus saquinavir 400 mg twice daily -- of the 53 persons remaining in the study at 12 weeks, the median viral RNA level declined by 99.9% (2.97 logs) and the median CD4 cell count increased by 95 cells. This demonstrated that not only did the combination of ritonavir and saquinavir enhance activity initially but that this activity continued and increased over time.
Nevirapine in Pediatric Patients
Results of ongoing clinical trials demonstrate that nevirapine (Virammune, Boehringer Ingelheim/Roxane Laboratories, Inc.) has potent antiretroviral activity which is long-lasting when used in combination with the nucleoside analogues zidovudine (ZDV) or ZDV plus didanosine (ddI) for HIV-infected children, stated Dr. Sany Burchett, assistant professor of pediatrics, Harvard Medical School and Children's Hospital, Boston, Massachusetts.
To date, 39 infants and children have participated in these trials receiving nevirapine either as monotherapy or in double or triple combinations. Patients receiving combination therapy have been maintained on this approach for a minimum of six months and as long as four years.
Using the triple combination of nevirapine, ZDV, and ddI, a durable reduction of plasma RNA levels (mean 93%) was observed through a minimum of six months of study. Of equal importance, CD4 T cell numbers were maintained in the normal range for the age of the patients.
Nitazoxanide for Cryptospordial Diarrhea
Nitazoxamide (Unimed Pharmaceuticals), a chemical compound with activity against a wide range of bacterial, protozoan, and helminthic pathogens, may be a major breakthrough in the treatment of AIDS-related cryptosporidial diarrhea, markedly reducing diarrheal episodes and significantly decreasing or even eradicating the oocysts of the cryptosporidia, declared Dr. Rosemary Soave, professor of medicine and public health, division of international medicine and infectious diseases, The New York Hospital-Cornell Medical Center, New York, New York.
In a recent study, 10 AIDS patients with potentially life-threatening chronic cryptosporidial diarrhea were treated with oral nitazoxanide at doses ranging from 500 to 2000 mg per day, for four weeks. If the diarrhea persisted, the patients received an additional four weeks of nitazoxanide treatment, up to 2000 mg daily.
Of the 16 persons who were evaluable at the eighth week of therapy, 12 had a greater than 50% reduction in daily bowel frequency and 10 had a marked reduction or eradication of the cryptosporidial oocysts in the stool, with the oocysts becoming undetectable in four individuals. There was a trend toward greater likelihood of response at high daily doses of drug and with longer duration of treatment.
Erythropoietin for Non-ZDV-Induced Anemia
Recombinant human erythropoietin (EPO) (Procri, Ortho Biotech) has proven to be useful in relieving AIDS-associated anemia not induced by ZDV, pointed out Dr. Hank Belfour, professor of laboratory medicine/pathology and pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota.
In a retrospective analysis of data collected from 1,943 AIDS patients not taking ZDV, who participated in an open-label EPO treatment program (mean weekly EPO dose of 354 to 465 IU/kg for approximately 17 weeks), results in persons not being treated with ZDV were almost the same as previously reported in patients with ZDV-induced anemia. Hematocrit readings rose to 30.8% at week six of EPO treatment and remained between 32% to 34% over the next 18 weeks. Also, transfusion requirements (more than one per week) fell from 43% before study entry to 18% for weeks 18 to 24 of the study.
This novel finding has important therapeutic implications because HIV is being treated with combinations of anti-HIV drugs, some of which do not include ZDV. Anemic AIDS patients not taking ZDV now have an alternative treatment other than blood transfusions, which have been shown to increase mortality in HIV-infected persons.
Editor's Note: It's important to recognize that there are people who do not thrive well on ritonavir-saquinavir, or other drug combinations. If you are an individual who does not do well, please remember that you are not alone. Body Positive will be taking a look under the silver lining of the new "wonder drugs" in the near future.
Report from the Third International Conference on Drug Therapy in HIV Infection
Birmingham, United Kingdom
This article was provided by Body Positive. It is a part of the publication Body Positive.