Magazine article Drug Topics

New AIDS Approaches

Magazine article Drug Topics

New AIDS Approaches

Article excerpt

User-friendly regimens coming for HIV patients,

say researchers

That unlovely collection of fat around the neck of longtime antiretroviral therapy users, referred to as a "buffalo hump," may just be a sign that the drugs are working, said researchers at the recent International Conference on AIDS, held in Geneva, Switzerland. They are more worried about the lipid abnormalities that often go along with the abnormal fat deposits.

"If you asked me two years ago, I would have said, 'Who cares if the cholesterol is going up?' because the life expectancy was so short," said Sven Danner, M.D., professor of medicine at the University of Amsterdam. Now that patients are suppressing the virus and living longer, though, he and others said it is time to counsel them about diet and exercise and in some cases prescribe cholesterol-lowering drugs to prevent heart attack or stroke.

The exact extent of the lipodystrophy problem-and, indeed, its exact definition-has eluded researchers so far. However, in general, it "refers to a cluster of complaints now being noted in patients who have taken highly active HIV-drug regimens for a long period of time, and it consists of abnormal distributions of fat, including a hump behind the neck and enlargement of the arms and legs and, in women, a complaint of enlargement of the breasts," Charles Flexner, M.D., associate professor of medicine, pharmacology and international health at Johns Hopkins University, said in an interview. It may also include a thinning of the face.

"It's unclear whether this is a direct effect of the drug or whether it's because when you have HIV infection for a long period of time, you develop wasting. Then when you come along and suppress the virus, you get a reversal of that effect, and the manifestation of that might be this lipodystrophy syndrome."

Among the promising easier-to-take regimens reported at the conference was the use of two protease inhibitors alone, given twice a day. In a 72week study, Danner found that 87 of 97 patients on a combination of ritonavir (Norvir, Abbott) and saquinavir (Invirase, Hoffmann-La Roche) had good viral suppression along with a substantial rise in CD4 cell counts. This combined regimen was especially tolerable, he reported, because both protease inhibitors could be given at lower doses, thus reducing side effects. The two protease inhibitors also have different side effects.

Danner said comparing this regimen with one that also included a nucleoside analog showed that, overall, the triple therapy was better. "But if the effect was not good enough after 12 to 18 weeks with the protease inhibitors alone, we could add the nucleoside analog, and the patients would come to the same point as the others by the end of the study. …

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