The Washington Blade - August 11, 2000
One of the most commonly prescribed nucleoside analogs -- d4t
or stavudine -- may be capable of causing a life-threatening
liver dysfunction in a small percentage of patients, notes an
article from a National Institutes of Health team. The syndrome
-- known as hepatic steatosis and lactic acidosis -- had been
associated with use of two other nucleosides, AZT and ddI,
since the early 1990s. It causes fat degeneration in the liver,
accumulation of lactic acid, and disease of the muscles.
The NIH team, reporting in the Aug. 1 issue of the Annals of
Internal Medicine, said it found four patients, diagnosed in
1997, who also appeared to have the symptoms as a result of
d4t is the second most widely used nucleoside, noted the
report. It is produced by Bristol Myers Squibb and marketed
under the name Zerit.
"Initial symptoms may be mild and nonspecific, such as nausea
and abdominal discomfort," noted the authors, "this may lead to
a delay in diagnosis until patients are severely ill."
The team recommended doctors monitor patients on d4T every
three to four months to watch for symptoms and to consider
nutritional supplements for possible deficiencies in riboflavin
Warning on abacavir: Avoid interruptions
And with all the recent focus on "strategic treatment
interruption," the Glaxo Wellcome pharmaceutical company
decided it was a good idea July 27 to send out a reminder
notice to doctors that stopping and starting its nucleoside
analog abacavir could have potentially life-threatening
The Food and Drug Administration approved the nucleoside analog
(sold under the trade name Ziagen) in December 1998 and noted,
at that time, that about five percent of patients who take the
medication had a "potentially fatal" allergic reaction to it.
The letter July 27 notes, however, that "severe or fatal"
reactions can occur in people who have not previously shown any
allergy to the medication. It urges doctors to be sure that
patients who stop taking abacavir are not allergic to the drug
before starting the medication again and that restarting the
drug should take place "only if medical care can be readily
accessed by the patient and others."
One of the less publicized but more interesting reports at the
International Conference on AIDS last month -- a report from
Spain -- was a psychological study of the appeal of being able
to stop taking the burdensome pill regimens required by most
triple drug therapies. The researchers found that the appeal is
so great that "patients are more interested in stopping their
therapy than in controlling the virus."
In brief ...
ABT-378: Abbott Laboratories� new once-a-day protease
inhibitor, ABT-378, is now more widely available. The drug is
intended for use with Abbott�s other protease inhibitor,
ritonavir. According to a press release from the company Aug.
4, the antiviral, also known as lopinavir, has been available
to only certain patients with HIV and specific criteria, due to
the company�s limited supply. People with HIV interested in
obtaining ABT-378 should call Abbott at (888) 711-7193.
CHECKING FOR TB: The U.S. Centers for Disease Control and
Prevention reiterated a warning this month that all people with
HIV who have any close contact with tuberculosis should be
evaluated for TB infection and, even if they test negative for
TB, should be given preventive treatment. In the Aug. 4
Morbidity and Mortality Weekly Report, the agency noted that
people who are in close contact with people who have active
tuberculosis -- either prolonged periods of time, frequently,
or physically close -- are at significant risk of contracting
TB. The agency studied more than 8,000 people in "close
contact" with tuberculosis in 11 cities and identified 109 who
also had HIV infection.
Nineteen percent of those with HIV infection also had active
tuberculosis, compared to only 2 percent of the people who did
not report having HIV.
SALVAGE POSSIBILITIES: A study in London, reported at an HIV
treatment conference in Spain in June, indicated that a salvage
therapy of five drugs -- efavirenz, hydroxyurea, ddI,
ritonavir, indinavir -- appeared to successfully suppress HIV
in two-thirds of 92 patients who had failed on a protease
inhibitor combination. At this same conference, a separate
report found that about 41 percent of 52 patients who had
failed two previous combination regimens experienced success on
a four-drug salvage regimen of efavirenz, hydroxyurea, ddI, and
NON-NUKE VULNERABILITY: A study from three countries, including
the U.S., and presented at the HIV treatment conference in
Spain found that "The prevalence of resistance to
[non-nucleoside analogs] is approaching 50 percent and has
implications" for the successful use of these drugs in treating
HIV. Non-nucleosides include efavirenz, nevirapine, and
delavirdine. Overall, noted the report, only 21.8 percent of
11,990 blood samples tested were still sensitive to all types
of anti-HIV medications.