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The
latest treatment guidelines for antiretroviral treatment of
HIV can be found on the web sites:
www.hivatis.org (USA guidelines)
www.aidsmap.org (BHIVA
guidelines)
The
State of Resistance Testing
In
an American HIV/Aids newsletter Gil Shepard wrote:
“The
goal of combination therapy is to create a hostile environment
in which HIV is incapable of replicating at all. While we have
not reached this ambitious goal, drug therapy can suppress viral
replication to the point where HIV is undetectable by currently
available assays.
Yet,
combination therapy does not always make the environment as
hostile as it needs to be. In such cases drugs may effectively
prevent the replication of wild-type virus yet create an environment
in which mutant viruses are actually more fit than they would
otherwise be. These drug-resistant strains of HIV can replicate
in the presence of drugs and viral load starts to rise.
What
should be done?
The
standard answer has been to switch to an entirely new combination
of drugs, if possible. The International AIDS Society-USA Resistance
Testing Consensus Panel is revising its recommendations based
on more recent studies of resistance testing. And this makes
sense if you don't know which drug or drugs the virus has become
resistant to. But genotypic and phenotypic resistance tests
hold out the promise of more educated choices. Ideally, these
tests would allow people to remain on drugs that are effective,
eliminate drugs that are ineffective, preserve more options
for future regimens and even improve virologic response whilst
lowering the cost of therapy.
The
full article that covers the advantages and disadvantages of
both types of resistance tests appears on pages 19 to 24 in
the winter 1999-2000 edition of ‘GMHC treatment issues’ newsletter.
www.gmhc.org
St
Johns Wort (update)
The
MCA (Medical Control Agency) warns that St John’s Wort may theoretically
affect blood levels of all protease inhibitors and levels of
the NNRTIs efavirenz and nevirapine. The agency has issued factsheets
for health care professionals and for patients, and suggests
that people taking anti-HIV drugs who have started taking St
John’s Wort since their last viral load test should contact
their doctor for a viral load test to check if the herbal medicine
has had any adverse effect on levels of prescribed medication.
The
MCA also warns that people who stop taking St John’s Wort may
experience toxicities caused by a rapid rebound in blood levels
of certain prescription medications, including anti-HIV drugs.
The
factsheets can be downloaded from the Medicines Control Agency
website
(Source www.aidsmap.com news March 2nd 2000)
L-Acetyl
Carnitine (LAC) improves symptoms of peripheral neuropathy
Peripheral
neuropathy can be one of the most difficult symptoms to manage,
and one that significantly effects the quality of life. Estimates
range from 10-35% of HIV positive patients and from 11-55% patients
who use ddC, d4T, ddl or 3TC.
For
people who have no other remaining choices for antiretroviral
therapy, or where the severity of symptoms has been underestimated
and neuropathy has progressed, there are currently no effective
pathogenesis based therapies.
A
recent study by Mike Youle in the new HIB treatment bulletin
‘I-Base’ says that all four patients in the study reported an
improvement in symptoms.
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