Despite the effectiveness of anti-HIV therapy and considerable success in reducing the price of the drugs in resource poor settings, the relentless spread of HIV continues to overwhelm all efforts to contain it. AIDS cannot be stopped without an effective means of preventing future infections. Unfortunately, the quest for a vaccine continues to elude our best scientific efforts. The new vaccines that looked so promising a few short years ago have produced disappointing results in early human studies. What happened in the animal models does not seem to happen in humans.
This article will briefly cover the ongoing research into the causes and possible treatments for lipoatrophy in general. It will also focus on newly approved and experimental facial fillers and implants.
A long-awaited expanded access program for the new protease inhibitor tipranavir should make it available for 3,000–5,000 people starting in mid-to-late November. The main advantage of tipranavir is that it appears to remain active to some degree even in people whose virus has developed resistance to multiple protease inhibitors. Studies in people with multi-drug resistance have shown considerable success.
In June 2004, a supplement was added to the Federal Guidelines for the use of anti-HIV drugs during pregnancy. These guidelines focus on mother-to-child transmission of HIV and discuss treatment strategies that can reduce the risk of an HIV-positive woman transmitting HIV to her child. The update included information on the use and potential risks and benefits, to both mother and child, of each of the approved anti-HIV medications. This article will briefly highlight the new recommendations. For more information on pregnancy and HIV, call our hotline at 1-800-822-7422 and ask for Project Inform’s publication, Pregnancy and HIV.
A recently published study found that an anti-diabetes drug, called rosiglitazone (Avandia), is able to reverse the loss of fat under the skin (lipoatrophy) that some people with HIV experience. While these results are encouraging, they are just the latest in a series of conflicting study results involving two different glitazone drugs.
Since the early days of AIDS research, some scientists have wondered if HIV could be slowed or rendered harmless by another virus. A number of studies suggest that hepatitis G (GBV-C) may be just such a virus, reducing disease progression and death in some people who are co-infected with both HIV and GBV-C. The authors of a recent article in The Lancet, went so far as to suggest that GBV-C be used as a model for designing new treatments for HIV. Other researchers, however, remain skeptical that GBV-C is responsible for slowing down HIV. Nevertheless, the findings so far demand further research.
Researchers have known since the mid-1990s that some versions (strains) of HIV are less potent than others. Yet only recently have a number of studies sought to determine whether reductions or increases in HIV’s ability to reproduce (i.e. replication capacity) can be measured accurately and if these measurements could provide a useful tool for HIV research, and monitoring HIV progression and the effectiveness of therapy. While more research is needed, emerging data suggest that developing an effective test of HIV replication capacity is not only possible, but that such tests may become an important new tool in the fight against HIV disease.
It’s well known that baboons and most monkeys cannot be infected with HIV, but until recently it wasn’t known why these animals are protected from HIV infection. While there are related viruses that can infect non-human primates, called simian immune deficiency virus (SIV), those viruses rarely cause disease in the animals. Researchers have recently discovered a protein that these animals produce, called Trim5-alpha. It appears to block HIV infection of cells, though has little to no effect on SIV. Humans produce a form of Trim5-alpha, but the human form does not block HIV as well as the animal form of the protein.
The price of drugs is a major factor contributing to the escalating cost of healthcare in America. Within HIV disease, the advent of effective but expensive treatment illustrates the problem. People with adequate access to healthcare routinely live 20 years or longer with HIV. Yet the net cost of the drugs needed over such a long period has become a huge burden. Programs that assist people with purchasing drugs, such as the AIDS Drug Assistance Program (ADAP), are failing to meet the need, due to a mix of excessive prices and increasing demand. More and more people in the U.S. are finding themselves without access to treatment.
New drugs similar to those already approved are in the research pipeline; yet only one, tipranavir (from Boehringer Ingelheim), may get Food and Drug Administration (FDA) approval in 2004. Drugs of new classes and different modes of action are discussed elsewhere in this issue of S but they will not be in wider use for two years or more.
Results from two studies confirm the benefits of the protease inhibitor atazanavir (Reyataz) with regard to side effects. Several studies show that other protease inhibitors can reduce insulin sensitivity in the body. Reduced insulin sensitivity can lead to diabetes.
A study (ACTG5097) was designed to determine whether higher levels of efavirenz in the blood are related to side effects of the central nervous system (CNS). CNS side effects, including vivid nightmares, difficulty sleeping and mood changes have been reported in a number of efavirenz studies.
Current anti-HIV drugs work at three points in HIV’s life cycle. Entry inhibitors, like enfuvirtide, keep HIV from entering cells. Reverse transcriptase inhibitors—like AZT, tenofovir and efavirenz—keep HIV from changing its genetic structure. Protease inhibitors, like atazanavir and Kaletra, ensure that newly made viral particles aren’t assembled into infectious virus.
Project Inform’s treatment and research advocacy goals are to 1) Facilitate research toward a cure for AIDS; 2) Focus research on issues facing people with advanced stage HIV disease; 3) Address treatment access issues; 4) Address standard-of-care issues; and 5) Remain nimble and responsive to emerging information and issues.
Entry inhibitors are a new class of anti-HIV drugs that work by blocking the virus’ ability to infect a cell. There are two general types of entry inhibitors: fusion inhibitors and attachment inhibitors. They may be joined by a third type in future years.
Manipulating the body’s cells and genes to treat disease holds great potential, but it is a field of research in its infancy. It will likely not yield results for years or perhaps decades as it takes baby steps towards progress. And although dramatic advances in treating HIV are not expected to come soon, its byproducts—such as information about the immune system and HIV infection—may contribute to short-term advances. This article provides an overview of the reasons for and challenges of gene therapy research.
The promise of drug delivery strategies is in their potential to improve current treatments and create opportunities for experimental therapy. Drugs that are absorbed through the skin or the nose instead of taken as a pill could help people reduce side effects and improve adherence. Drugs that are injected daily could instead be given through an implant once a year or through skin patches. Time release technology might allow for drugs now taken three or more times a day to be taken once a day or even once a week.
The promise of drug delivery strategies is in their potential to improve current treatments and create opportunities for experimental therapy. Drugs that are absorbed through the skin or the nose instead of taken as a pill could help people reduce side effects and improve adherence. Drugs that are injected daily could instead be given through an implant once a year or through skin patches. Time release technology might allow for drugs now taken three or more times a day to be taken once a day or even once a week.
When President Bush took office almost three years ago, there was considerable anxiety about how people with HIV/AIDS would fare. His record on AIDS issues as governor of Texas was not impressive, and he spoke little about what he would do to fight the disease during his campaign.
Have you ever heard someone say, "I don't want HIV to take over my life. My life is more than my HIV status?" Perhaps you've had similar feelings or felt overwhelmed with trying to manage your health. This article provides a different way of thinking about health than what many people may experience at a doctor's office. The goal is to offer a framework for thinking about a big picture of well-being and provide a path for developing a long-term strategy to promote and maintain overall general health.
Deciding when to start anti-HIV therapy and what treatments to start with can leave many people feeling overwhelmed with choices. The discussion following, however, will demonstrate that the choices may be fewer and simpler than they appear at first. Charting your course of therapy options up front, outlining what therapies you will start with when you’re ready and what you will switch to if that option doesn’t work out, is the hallmark of long-term planning.
The human immunodeficiency virus (HIV) infects immune cells, impairing their function and eventually destroying cells over time. This gradually weakens the immune system and the body loses the ability to fight disease. While HIV is the culprit, most people who die of AIDS do not die of HIV, per se, but from the numerous infections that the body can no longer control due to the collapse of the immune system. Relatively common infections, which may cause little or no harm in a healthy person, take the opportunity provided by weakened immune defenses to cause disease. This is why they are called opportunistic infections (OIs).
STIs (Structured Treatment Interruptions) involve going off anti-HIV therapy for periods of time in a structured and strategic fashion, typically guided by increased lab and health monitoring. In all, more than two dozen studies of STIs of varying types have been conducted since 1998. It is important to note that interpreting the results of STI research can be challenging. Some of the assumptions about HIV disease that led researchers to investigate treatment interruptions in the first place have yet to be proven conclusively. At least some of the research on STIs, however, has been promising and other research has made clear those areas where interrupting therapy is neither safe nor effective.
Third line therapy, sometimes called salvage or rescue therapy, is a term describing treatment regimens for people who have few or limited anti-HIV drug options. This includes people who have failed at least two previous anti-HIV regimens and/or people with evidence of HIV resistance to at least one drug in each of three major classes
AIDS is a disease of primary immune dysfunction caused by HIV. To date, all of the approved and proven strategies for treating HIV disease focus on crippling the virus’ ability to infect and/or destroy these cells. There are no approved treatments directed toward the immune deficits and dysfunctions caused by HIV. The good news is that when HIV replication is slowed through the use of anti-HIV drugs, the immune system begins to repair itself and there is evidence of a degree of immune restoration when HIV is controlled over time.
This information is designed to support, not replace, the relationship that exists between you and your doctor.