In recent months there has been growing awareness of person-to-person differences in the way anti-HIV drugs are handled by the body. Two people with HIV may take the same dose of the same drug, but while one may achieve high enough levels in the blood to inhibit HIV effectively, the other may be absorbing too little dr
The US Public Health Service has issued an updated draft of its guidelines on the use of anti-HIV drugs. In perhaps the most significant change, the estimated risk of disease progression at different levels of viral load have increased sharply. Meanwhile, the pros and cons of the aggressive approach to therapy recommen
In recent months, AIDS Treatment Update has received several calls from HIV-positive people with haemophilia, concerned over reports that protease inhibitors may not be safe for them to take. The concerns stem from a letter sent by the US Food and Drug Administration to American doctors in July 1996. It reported 15 cas
A small pilot study has suggested that the effectiveness of d4T may be reduced in AZT-experienced people, because of changes in the way the body s cells handle the drug. Before they can exert anti-HIV effects, both AZT and d4T have to be converted into their active form by cellular enzymes, in a process called phosphor
Several studies presented at the Hamburg conference explored the effects of different dosing regimens for protease inhibitor. Indinavir is currently prescribed at a dose of 800mg three times daily. An American study compared 1000mg twice daily or 1200 mg twice daily instead. Preliminary results found no significant dif
Researchers on the Delta study, which compared with effects of AZT , AZT/ddI and AZT/ ddC , have reported on changes in viral load and the development of resistance among a sub-group of 240 trial participants in France , the
Studies about to begin at British clinics are investigating the role of new nucleoside analogue reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) in HIV therapy. **Twice-daily i
Several different sets of guidelines for anti-HIV therapy have been published by national and international bodies in the past year. Nearly all suggest that the optimal response to treatment is for viral load to fall below the limit of detection of current viral load tests. In AIDS Treatment Update issue 56/57, we ques
Many people taking ritonavir have been told that the drug must be kept in the fridge. In some cases this advice is causing considerable anxiety and practical difficulties. But according to the most recent advice from its manufacturer, Abbott, experiments show that the drug remains active provided that it is not exposed
The ADHOC trial has recruited eleven patients in the UK. Fifteen clinical centres have now started recruiting into the trial and another 18 centres are preparing to participate. The trial is about to start in Australia and other countries soon. ADHOC is a multi-national trial to assess the role of the drug adefovir dip
The Medical Research Council HIV Clinical Trials Centre, in collaboration with the Medicines Control Agency and the Committee on Safety of Medicines are shortly to launch a joint scheme to encourage more complete reporting of side-effects of anti-HIV drugs by doctors and pharmacists. The move follows concern that relat
French doctors have reported on two people whose viral load has remained below the limit of detection for one year after stopping all anti-HIV therapy. The two individuals started treatment with the combination of ddI plus hydroxyurea (see AIDS Treatment Update issue 26) within a year of becoming infected with HIV; eve
Several new trials are investigating the concept of a `subtractive approach to anti-HIV therapy, in which people receive aggressive treatment with three or four drugs to try to suppress their viral load to below the limit of detection, then switch to a less intensive two-drug regimen to try to maintain the suppression.
Dietary guidelines can be one of the most confusing aspects of the treatments prescribed for people with HIV. Many of the drugs come with advice on whether or not they should be taken with food and drink - or even with specific types of food and drink. In many cases these guidelines are just suggestions to try to reduc
During the last three months, many doctors on both sides of the Atlantic have started to advocate a more cautious attitude to treatment with the current formulation of saquinavir ( Invirase ). As reported in AIDS Treatment Update issue 56/57,
AIDS Treatment Update, Issue 56/57, August/September 1997
Interviews by Edward King
Since the days of the Anglo-French Concorde trial, there has been a view that British clinicians divide into two camps: interventionists and conservatives. Concorde found that there was no advantage to starting early treatment with AZT monotherapy, as opposed to waiting until symptoms or other signs of advancing immune
AIDS Treatment Update, Issue 56, August/September 1997
Edward King
As we reported last month, two sets of guidelines on the use of anti-HIV drugs were published in the USA in late June. One was a draft document for comment from the US Department of Health & Human Services, which is likely to be revised in the light of responses, while the other presented the recommendations of the
Recruitment to the ADHOC trial will begin shortly at the Royal Free Hospital, King s College Hospital, St George s Hospital and St Thomas Hospital in London, and at the General Infirmary at Leeds, Royal Hallamshire Hospital (Sheffield), Newcastle General Hospital and North Manchester Hospital. At least 20 more centres
The US Food and Drug Administration ( FDA ) has written to American doctors to warn them about cases in which people taking protease inhibitors developed increased levels of blood sugar (hyperglycaemia) or even diabetes, or their existing diabetes was made worse. 83 cases have been reported, 27 of which were severe
The first trial to assess the clinical benefits of starting treatment with a triple combination that includes a protease inhibitor has concluded that the disease progression rate was halved, compared with starting treatment with two nucleoside analogues alone. The 3591 participants in the trial, code-named SV14604, had
The MRC plans to start a trial for 200 individuals at major London and non-London hospitals in the UK in the next few months. This trial will explore whether following maximal suppression of HIV replication, the number of drugs can be reduced without a significant rise in HIV replication. Such an approach would have ad
Press reports about the success of combination therapies including protease inhibitors frequently mention that people are now feeling well enough to consider going back to work. In a recent survey at the Kobler Centre in London s Chelsea and Westminster Hospital 70% of those who returned the questionnaire were not work
A new class of anti-HIV drugs is becoming available in the UK. The non-nucleoside reverse transcriptase inhibitors (NNRTIs) attack the same HIV enzyme as the nucleoside analogue drugs such as AZT , ddI and 3TC , but in a different way, binding onto reverse transcripta
New draft guidelines on the use of anti-HIV drugs drawn up by a panel of American doctors, researchers and treatment activists recommend early, aggressive therapy including a protease inhibitor. The federal guidelines, released as this issue went to press, are likely to be viewed as the new gold standard in HIV therapy
In recent months many large cities in the USA have reported striking declines in AIDS deaths coinciding with the use of combination therapy and protease inhibitors . What has happened in the UK during the same period? UK surveillance statistics UK SURVEILLANCE STATISTICS The UK s national and regional HIV/A
If your current dual or triple combination appears to be failing, do you really need to switch to a completely new combination, or might you be able to selectively replace just one or two components? Clinicians are wary about just tinkering with a failing regimen because of the difficulty of knowing exactly which compo
Despite the current enthusiasm for triple combination therapy and protease inhibitors , the majority of HIV-positive people now receiving treatment in the UK are likely still to be taking a two-drug combination of nucleoside analogue reverse transcriptase inhibitors (NRTIs), such as
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