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What's New in Treatment Information?

Excerpts From Hotline Memos of October, 2000
from the Information Department of Project Inform

November 2000

Lopinavir Warning

Abbott Laboratories, the developers of lopinavir (Kaletra, formally ABT-378), recently issued a warning about the possibility of developing pancreatitis (inflammation of the pancreas) while on the drug. Less than one percent of the participants in the studies and expanded access program developed pancreatitis.

It's not possible to definitively say that people developed pancreatitis from taking lopinavir, as some were also taking other therapies known to cause pancreatitis like pentamidine, ddI (didanosine, Videx) and/or d4T (stavudine, Zerit). Additionally, some volunteers had very high triglyceride levels, which can result in pancreatitis. Nevertheless, people on lopinavir should carefully check their amylase levels (a marker for pancreatitis).


Expanded Access for ddI (enteric-coated)

Bristol-Myers Squibb is starting an expanded access program for their new enteric-coated formulation of ddI (Videx) for people who cannot tolerate the existing tablet or liquid formulations. There are a few advantages to the new formulation: it is taken once a day; it does not have the buffer now found in the tablets and as a result should result in fewer gastrointestinal side effects; and it does not have to be taken an hour before or after other drugs such as indinavir (Crixivan). However, enteric-coated ddI still needs to be taken on an empty stomach (30 minutes before or two hours after eating).

To qualify for the program, you must:

  • Have a CD4+ cell count below 200 within the past twelve weeks.

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  • Be intolerant to the currently available formulation of ddI as confirmed by your physician.

  • Be failing or failed (rebound in viral load) on one or more potent anti-HIV regimen.

  • Have no history of acute or chronic pancreatitis (inflammation of the pancreas), a side effect associated with ddI.

  • Have no liver function test abnormalities (less than four times the upper limits of normal).

  • Have no ongoing moderate-to-severe peripheral neuropathy (a tingling sensation or pain usually in the hands, legs, or feet), another side effect associated with ddI.

  • Not have diarrhea (more than six loose stools per day for seven days or more).

  • Not be on other drugs that can cause similar side effects to ddI, such as intravenous pentamidine, systemic chemotherapy, allopurinol or hydroxyurea.

In order to participate in this expanded access program, your physician must call 1-877-418-3889 to register.


New Women's Publication!

Project WISE, Project Inform's HIV treatment information and advocacy program for women, is pleased to announce the availability of its newest publication, "Positive? How are you feeling?" This colorful and informative booklet for women living with HIV focuses on physical and emotional wellness in the context of providing basic information on HIV disease and its management. Available in English and Spanish, the publication can be ordered by calling Project Inform's National HIV/AIDS Treatment Hotline at 1-800-822-7422. It is also available through Project Inform's Web site at www.projectinform.org/pub/Ww1/bridge.html.


DNP Poly-A: The Glove Fits

From GMHC Treatment Issues - Vol. 10, No. 12, Dec. 1996

[Note: Although this article is dated 1996, the information is still current and relevant therapy.]

The reverse transcriptase enzyme, which converts HIV's RNA gene set into DNA before the virus inserts itself into cells nuclei, often has been compared to a hand, complete with a palm, fingers and thumb. The fingers and thumb grab a hold of the nucleotide building blocks and attach them to the growing strand of HIV DNA, lying in the "palm" of the enzyme. This analogy was first made several years back, when the three-dimensional structure of the reverse transcriptase enzyme was discovered.

Knowing the enzyme's structure could have important implications in the design of new, more potent reverse transcriptase inhibitors. Ten years ago, discovery of the three-dimensional structure of the protease enzyme led to the discovery and development of protease inhibitors.

A group at State University of New York (SUNY), Buffalo has used reverse transcriptase structure to design a chemical, DNP poly-A, that fills the entire nucleotide binding region of the enzyme, in a fashion similar to how protease inhibitors fill the active site of the protease enzyme. When DNP poly-A was added to HIV-exposed cells, the cells did not become infected.

DNP poly-A is a sequence of nucleotides (an oligonucleotide). Usually, if strands of such material are found floating around in the blood or outside of protected areas like the cell nucleus or mitochondria, they are treated by the body as noxious garbage or enemy viral genes and quickly destroyed by special enzymes. Most oligonucleotide drugs similarly are broken down before they can reach their targets. The researchers from SUNY do not believe that this will be a problem with DNP poly-A, because the drug was stable even after prolonged incubation in cell cultures with a variety of enzymes known to cut up strands of nucleotides.

Next, the researchers administered the drug as an injection to mice with murine leukemia virus, which has a reverse transcriptase enzyme very similar to HIV's. Viral load dropped to undetectable levels in the mouse blood, and there was little toxicity. One problem with the compound, is that even though the team has modified it to increase its absorption from the digestive tract, it still looks as though DNP poly-A will have to be administered as an injection.

There is no word yet if any pharmaceutical company is interested in developing this compound.


Back to the What's New? November, 2000 Table of Contents.



  
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This article was provided by Project Inform. It is a part of the publication What's New. Visit Project Inform's website to find out more about their activities, publications and services.
 
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