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AIDS Cocktail Patients May Not Need Pneumonia Drug


BOSTON (Reuters) - Two studies offer new evidence that people with the AIDS virus can safely stop taking drugs designed to prevent deadly pneumonia as long as their immune systems have rebounded with the help of the "AIDS cocktail" of protease inhibitors.

The findings, reported in Thursday's New England Journal of Medicine , suggest that as long as the number of infection-fighting cells known as CD4 lymphocytes does not fall below 200 per cubic millimeter of blood, the AIDS-related pneumonia known as Pneumocystis carinii will not appear.

The researchers said such patients are also unlikely to develop pneumonia even if tests show the human immunodeficiency virus (HIV) -- the virus that causes AIDS -- is still detectable in the blood or if they have already survived one bout of pneumonia, which puts them at a higher-than-average risk for developing it again.

Previous studies have reached a similar conclusion and an accompanying editorial said the results were good news for AIDS patients in the developed world.

"The consistency of the results ... is reassuring," wrote Dr. Pierre-Marie Girard of the Saint Antoine Medical Facility in Paris in an accompanying editorial.

The editorial added, however, that the studies underscored the huge disadvantages faced by AIDS patients in poor countries, who cannot afford the cocktail of drugs.

In Africa, where some 25 million of the world's 35 million AIDS patients live, most have no hope of accessing the most effective treatments for AIDS even though Western drug companies have started to cut prices.

"All these studies are good news for people living with HIV," Girard said, "but they also make the gulf in treatment between rich and poor countries even more glaring and unacceptable."

In a similar study two years ago doctors from the Bern Hospital in Switzerland reported in the Journal that none of the 262 volunteers taken off pneumonia-preventing drugs developed AIDS-related pneumonia as long as their CD4 counts remained over 200.

That same year, a task force of the U.S. Public Health Service and the Infectious Diseases Society of America advised doctors they could stop giving drugs to prevent the pneumonia if the white blood cell counts rose.

Before the development of the combination of drugs known as the "AIDS cocktail," AIDS-related pneumonia ultimately afflicted about 80 percent of patients whose CD4 counts dropped below 200. It often killed them.

In one of the new Journal studies, conducted in 1998 and 1999 at 19 Spanish public hospitals, a research team led by Dr. Juan C. Lopez Bernaldo de Quiros at Hospital Gregorio Maranon in Madrid took 300 volunteers off the medicines designed to prevent AIDS-related pneumonia.

They stayed off the medicine as long as their CD4 counts remained above 200.

Another 287 AIDS patients were kept on the pneumonia-preventing drugs.

Nobody in either group, 38 percent of whom had the AIDS virus circulating in their blood, contracted Pneumocystis carinii pneumonia, whether or not they had had it before.

The second study, led by Bruno Ledergerber at Zurich University Hospital in Switzerland, came to a similar conclusion after studying 325 people from October 1996 through January 2000, all of whom had already recovered from one bout of AIDS-related pneumonia.


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Information in this article was accurate in January 17, 2001. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.