Though much of the American media continues to believe that AIDS has become a non-issue nationally, it has at least recognized the growing severity of the problem in the developing world. But whether speaking from the perspective of women, gay men, children, injection drug users, people with hemophilia, or any community in the "changing face of AIDS," unresolved problems continue to threaten the lives and well-being of HIV-positive people nationwide.
Compared to previous years, advances in the field of HIV antiviral research today are few and far between. Only a handful of new drugs in development block HIV reproduction by new mechanisms. Most experimental anti-HIV drugs are simply improved versions of existing therapies or new variations of those currently available.
Women living with HIV often experience changes in their menstrual cycle, including the flow and frequency of menstruation. A recent study suggests that women using the drug ritonavir (Norvir®) as part of their anti-HIV combination therapy may be at a greater risk for anemia (a decrease in red blood cells) due to excessive menstrual bleeding, a condition known as hypermenorrhea.
After being withdrawn from the market for almost a year due to complications in the manufacturing process, ritonavir (Norvir®) is once again available. This eliminates the need to drink the unpleasant liquid form of the drug. The newly formulated soft gel capsules are already in pharmacies.
There has long been a love-hate relationship with ddI (didanosine, Videx®) in the HIV community. The drug has repeatedly demonstrated its potency and laboratory studies (with some confirmation from human studies) show that resistance to ddI develops very slowly.
Amprenavir (Agenerase®), the most recently approved protease inhibitor, is often used by people who have lost responsiveness to one or more of the previously available drugs of this class.
From the fall of 1996 through the first half of 1998, the Centers for Disease Control and Prevention reported encouraging reductions in the death toll from HIV/AIDS. At least some of the reduction has been attributed to the effectiveness of the new three-drug combinations using protease inhibitors in prolonging life.
Legislation is making its way through Congress that could improve health care access for working people with disabilities. The Senate bill is called The Work Incentives Improvement Act, S. 331, and the companion bill in the House of Representatives is H.R. 1180.
A Data Safety and Monitoring Board or DSMB (the group charged with monitoring the safety of a study) recommended the closure of a large study of HIV-1 Immunogen (Remune®). The study included thousands of volunteers and continued for a number of years. On a monthly basis, half of them received the injectable product, Remune®, and half received a placebo injection, monthly.
A recent study in the Journal of the American Medical Association reported a 67% decline in the rate of mother-to-child HIV transmission between 1993 and the present. While this is welcome news, the understandable zeal to prevent mother-to-child HIV transmission (vertical transmission) has too often overshadowed the long-term goal of providing optimal HIV care to women during and after pregnancy.
Studies suggest that the majority of mother-to-child HIV transmission (vertical transmission) occurs during labor and delivery, thereby fueling a debate about the safest route of child birth. This debate centers around the risks and benefits of Cesarean-section (abdominal surgical delivery) performed before the onset of labor (called elective C-section) versus natural, vaginal delivery.
New methods to prevent the transmission of HIV from pregnant women to their unborn babies have gained much attention recently. Indeed, while the effort to reduce mother-to-child HIV transmission (vertical transmission) is important worldwide, it is particularly so in many developing nations where transmission rates remain alarming high due to complex social and economic complex factors.
The US Public Health Service and the Infectious Disease Society of America recently issued new guidelines for the prevention of opportunistic infections (OIs). The revised guidelines take into account the increasingly common practice of stopping preventive treatment (to reduce the risk of getting a particular infection) and maintenance therapies (to prevent relapse) when someone has sustained CD4+ cell count increases as a result of highly active anti-HIV therapy.
HIV resistance testing measures the degree to which HIV in a person has become resistant or less sensitive to anti-HIV drugs. Two major studies show that people who use resistance testing results to help make treatment decisions experience a better and more sustained reduction in HIV levels than those who make decisions based only on previous treatment history and viral load.
Presentations on pediatric AIDS at the recent Retrovirus Conference focused on broadening treatment options. Highlighted were studies of anti-HIV therapies, particularly protease inhibitor (PI) containing regimens. While encouraging, studies elicited concerns of adherence and long-term side effects.
Several studies of IL-2 were reported at the recent conference. Together, they confirm the ability of IL-2, when added to anti-HIV therapy, to produce dramatic CD4+ cell count increases above what is observed when anti-HIV therapy is used alone. Moreover, study results confirm the safety of IL-2 with regard to its impact on HIV replication.
Until recently, the incidence of opportunistic infections (OIs) had been steadily decreasing. This is partially a result of the use of effective anti-HIV combination therapies containing a protease inhibitor (sometimes called Highly Active AntiRetroviral Therapy or HAART) and partially a result of a general decline in the nmber of people infected several years ago.
Research has begun on two new strategies for long-term treatment of HIV disease. Although both theories involve taking people off treatment in some way, they have different goals and expectations. These two strategies are known as pulsed therapy and structured interruptions of treatment (sometimes called drug holidays).
A study reported at the recent Chicago conference suggest that women are more likely to develop rash, especially severe rash, as a side effect of the anti-HIV drug nevirapine compared to men. Researchers looked at the medical records for 85 women and 176 men receiving nevirapine-containing anti-HIV regimens between 9/93 and 9/98.
In contrast to the numerous treatment strategy options now available to people who are just starting first or second line anti-HIV therapy, limited choices are available to people exploring "third line" therapy options. Third line therapy refers to any treatment regimen used after two initial rounds of therapy have proven unable to maintain HIV suppression.
Beginning with this issue, Project Inform will change some words commonly used in HIV/AIDS newsletters and presentations. Constituent feedback remind us that words can convey unintended meanings. At their worst, seemingly innocent words can lead to discouragement, or they can insult the listener or reader. They can also carry the wrong message.
The widespread availability of the next generation of new anti-HIV therapies is still at least a year or more off. However, most of them are currently in, or will soon be in, small studies; a few are already moving into large-scale studies.
The latest buzzword of HIV treatment is the so-called "protease inhibitor-sparing" regimen. This concept describes an effective three-drug treatment combination that does not use a protease inhibitor (PI). At its simplest, the goal of such a regimen is to preserve or "spare" the protease inhibitor option for later use. There are now reports of similar regimens that spare two classes of drugs, withholding the use of protease inhibitors and non-nucleoside RT inhibitors (NNRTIs) for later use.
This year's Sixth Conference on Retroviruses and Opportunistic Infections, held in Chicago January 31 to February 4, presented a mixed bag of new data on the treatment of HIV disease.
This information is designed to support, not replace, the relationship that exists between you and your doctor.