Infosheet #5 For a Better QL of PLWHA! DRUG HOLIDAYS. YES OR NO? (the VII CROI: Conference on RETROVIRUSES and OPPORTUNISTIC INFECTIONS,
This conference is rated as the highest forum on scientific and clinical HIV and OI research.
The question when to start therapy is stil essential. The Washington university clinical study shows that a delayed start results in better virology outcomes and less opportunities for developing resistances. There is no evidence on an improved immune system or HIV eradication by starting early (abstr. #523).
Since the firstcombination fails in half of cases, it has to be chosen carefully (R. Murphy, MD). Mixing the 16 ARV drugs theoretically gives 3360 combinations. Here are some of them. E.g., ABC + AMP quickly suppresses HIV- 1 replication and is usually well tolerated (#336). NVR + ZDV + LMV is equal y effective in patients with low and even high VL (>100.000) (#517).
nce daily Emtricitabine (FTC) + ddI + EFV in therapy- naïve patients after 24 weeks lowered VL<400, increased CD4 cel count and was well tolerated
(#518). Once daily EFV + NVP combination:it may be necessary to increase the EFV dose to 800 mg (#80). Single pill combination of ABC + LMV + ZDV (twice daily) is biologically equal to its contents, has no dietary restrictions, is well- tolerated, easy to swallow and not disgusting (#98).
In order to evade cross- resistance – do not use combinations consisting of al the 3 ARV classes (#80)! Using NLF as the first PI causes less cross- resistances compared to other PIs (dr. L. Prescott).
Discussion on drug holidays stil goes on. 5/8 of patients on HAART had to restart therapy on the sixth week with their CD4 counts and CD4/CD8 ratios lowered. In contrast, patients on Hydroxyurea + ddI (“PANDA” clinical study) at the 8th week had a very smal VL increase at stable CD4 and CD8 counts. This is the first study showing that STIs in chronical y infected patients are feasible (#352).
60% of patients after 2 yrs on PIs are experiencing lipodistrophy. Switching to another ARV class does not guarantee its disappearance - lipodystrophy may not progress, though.
Some comparisons:Comparing PIs: AMP is less prone to cause lipodystrophy than IND. d4T causes much more lipodystrophy cases than ZDV (#756). 14% of patients after 3 years on RTV + SQV are experiencing shrinkage in buttocks (D. W. Cameron).
While due to ARV combinations the virus is decreasing in bloodstream, it may continue replicating in sperm. 33% of men on PIs are experiencing sexual dysfunction. Abbott has a new salvage in its pipeline – an erectile medication Uprima. Its effect is reached in 75% of men who sucked the pill for 20 min. Compared to Viagra it has less of side effects.
Newly elaborated blood tests help to define the approximate timing of HIV infection. These tests have proved that oral sex has been the cause of HIV transmission in 8% of cases in San Francisco (abstr. #473).
Another TCM doctor expelled from Health Bureau’s Healthcare Subsidy Scheme, due to accepting healthcare voucher to pay for ginseng and dried seafood products In the hope to partially lessen residents’ burden on medical expenditure, make good use of the medical resources available in community and promote the concept of family doctor, the government is subsidizing the local residents
NEWSLETTER # 33 – January 2006 PHARMACIENS SANS FRONTIERES COMITE INTERNATIONAL New format and new look for our monthly newsletter. We hope that you like it, and that delivery is successful. Your comments are welcome. Educational initiatives for medical and pharmacy students about drug promotion This very interesting study points out the limited amount of time and lack of import