Despite success in these areas, there also appear to be increases in the rate of certain AIDS-related cancers. Moreover, a major hospital is beginning to document new increases in the rates of OIs.
Volunteers were either continued their current MAC preventive therapy, azithromycin (Zithromax®, 1,200 mg once a week) or switched to a placebo. About 60% of them had good control of HIV with HIV RNA below 500 copies.
After over a year, only two people got MAC, both of whom took the placebo. These results imply that it's safe to stop MAC preventive drugs for people whose CD4+ cell counts increase to and remain over 100. If you wish to consider stopping your MAC preventive therapy, discuss it with your doctor.
At the start, all volunteers had CD4+ cell counts over 200, HIV RNA below 5,000 copies and were using HAART for at least three months. About 20% had been previously diagnosed with PCP.
Volunteers either continued PCP preventive therapy or received no preventive drugs. After almost a year, not a single case of PCP was diagnosed.
These results suggest that it's possible for people to stop PCP preventive therapy if they have sustained CD4+ cell count increases over 200 and stay on potent anti-HIV drugs that optimally control HIV.
An early report from a similar study, ACTG 888, appears to confirm these results. No cases of PCP have yet been reported in the 252 participants to date.
The federal guidelines for the treating opportunistic infections suggest that it's possible for people to stop primary PCP preventive therapy (to prevent first PCP infection) if they have sustained CD4+ cell counts over 200. However, the guidelines do not recommend that people stop secondary preventive or maintenance therapy (to prevent PCP from coming back). If you consider changing your PCP preventive therapy, talk to your doctor.
The new version of interferon-alfa is bound to polyethylene glycol, which helps the interferon to remain stable and active in the blood for longer periods than standard interferon.
In the study, people received 48 weeks of anti-HCV therapy with a follow-up period of 24 weeks when they did not take any therapy. They received either 90 micrograms (mcg) or 180 mcg of peg-interferon once a week or three million international units of interferon-alfa three times a week. Both formulas required injections under the skin.
Results showed that at 72 weeks, 29% of the participants receiving peg-interferon had undetectable blood levels of HCV compared to only 6% using standard interferon-alfa. Side effects were similar between the two formulas and included headaches, fatigue, flu-like symptoms, nausea, vomiting, depression, fever and chills.
In truth, neither of these success rates are overly impressive. Optimally, even the peg version of interferon may need to be used in combination therapy approach. Another study is ongoing in people who have both HIV and HCV to determine the effectiveness of peg-interferon combined with ribavirin (Rebetol®). Ribavirin combined with a standard form of interferon is called Rebetron® and is generally considered the current standard for treating HCV. Also, HCV advocacy groups including Project Inform are working with Hoffman-La Roche, the developers of peg-interferon, in designing studies that include complementary therapies. The new studies would determine if these therapies (such as milk thistle, coenzyme Q10 and vitamin B12) really benefit people with HCV infection.
It's not entirely clear why this is occurring. But one theory explains this may be a result of people living longer or that NHL was seen less frequently in the time before protease inhibitors because people died of other conditions before developing NHL. Immune restoration (increases in CD4+ cell counts) among people on HAART seemingly has little or no impact on NHL. Some researchers wonder if the extensive use of anti-HIV drugs might be contributing to the increase, but there is no clear evidence that this is the case.
Earlier HIV testing and better access to treatment and care may have prevented many of these infections. It's been noted that what happens in San Francisco usually happens in the rest of the country a year or two later. So, returns in rates of new AIDS-related infections may be expected over the coming years.
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