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Government Revises HIV Treatment Guidelines


WASHINGTON (Reuters) - AIDS experts, admitting that current drugs cannot ever cure HIV infection and that they can cause severe side-effects, issued new guidelines on Monday that advise doctors to wait a bit before treating patients. They have abandoned the idea of hitting the virus quite so early and hard -- unless the infection is caught within days -- and have said it is better to hold back until the infection reaches a certain point.

"Although antiretroviral therapy has provided extraordinary benefits to many patients, we know that we cannot eradicate HIV infection with currently available medications," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said in a statement.

"We also recognize that serious toxicities are associated with the long-term use of antiretroviral drugs."

Fauci said in an interview last month that the panel that makes the recommendations planned to be a bit more conservative. "Now we are saying you might want to start treating at a little bit lower CD4 count and a little higher viral load," he said, referring to the state of the immune system and the amount of virus spreading through the blood.

The new guidelines are available on the Internet at Cocktails of powerful drugs, sometimes three, four, five and even more, can hold the virus at bay. But doctors admit it is still difficult to decide which drugs to give first and which combinations are best.

"The updated guidelines recognize that we do not yet have the data we need to make definitive recommendations about the optimal time to start treatment," said Dr. John Bartlett, chief of infectious diseases at Johns Hopkins University in Baltimore, who served on the panel.

Guidelines Recommend Protease Inhibitors

But the guidelines, issued by the U.S. Health and Human Services Department (HHS) and the private non-profit Henry J. Kaiser Family Foundation, do name some favored drugs.

"One of these is the recently approved protease inhibitor Kaletra, which is a co-formulation of ritonavir (approved in 1996) and lopinavir," HHS said in a statement.

"The other new entry is the combination of ritonavir and indinavir. These treatment options take advantage of the ability of ritonavir to boost the levels of other protease inhibitors, creating a potent anti-HIV combination." Kaletra is made by Abbott Laboratories Inc. . Indinavir is made by Merck and Co. under the brand name Crixivan.

The new guidelines update the section on side-effects.

"We are very concerned about a number of toxicities associated with the long-term use of antiretroviral drugs," Fauci said.

"Particularly alarming is the alteration of fat metabolism that can emerge during treatment. We are seeing an increasing number of patients with dangerously high levels of cholesterol and triglycerides."

That risk, he said, is one reason to wait before starting treatment until it is really necessary.

But Dr. Benjamin Young, an AIDS specialist at Rose Medical Center and the University of Colorado in Denver, said it was important not to scare patients away from taking drugs.

"The fact that the recommendations are extended to issues related to long-term toxicity is accepting that ... we are dealing with long-term survival, and blessed by the fact that there are many antiretroviral drugs to choose from," Young said in a telephone interview.

"I tell my patients, 'You are a 40-year-old man and I would much rather have you die at age 65 of a heart attack than die at age 45 of AIDS'."

David Crawley, pharmaceuticals analyst at Schroder Salomon Smith Barney in London, said the new guidelines were unlikely to have a dramatic impact on prescribing patterns as many U.S. doctors had already altered their treatment patterns.

He said the new guidelines would not affect his forecasts for either GlaxoSmithKline or Swiss-based Roche, two of the world's leading producers of HIV drugs.


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Information in this article was accurate in February 5, 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.