Ribavirin: a role in HIV infection?

Article Abstract:

Ribavirin is an antiviral drug that works against various viruses, including retroviruses such as HIV (human immunodeficiency virus), which causes AIDS. In 1984, it was shown that ribavirin inhibited replication of HIV in cells grown in the laboratory. However, in clinical trials, it was shown that the dosage required to inhibit HIV could not be achieved in the body. Concentrations of one-tenth the level needed caused severe side effects in the blood and the central nervous system. A clinical trial reported in the September 1990 issue of the Journal of Acquired Immune Deficiency Syndrome compared the rate of progression to AIDS among HIV-infected patients who received one of two low doses of ribavirin or who were not treated. All of the patients were infected with HIV but were asymptomatic except for generalized lymphadenopathy syndrome (LAS), noticeably enlarged lymph nodes. The results of the study suggest that the higher dose of ribavarin was effective in preventing progression to AIDS. The study is flawed in terms of design, conduct, and analysis, and should not have been published. The flaws of the study include: abnormally high rates of progression to AIDS of patients who were not treated; the uneven randomization of subjects to the different treatments; the inclusion of a large number of patients in the study who had symptoms that should have made them ineligible for the study; the unlikelihood that the levels of the drug in the body that were achieved could be effective to inhibit the virus; and the lack of effect on virally-infected cells or cells of the immune system as demonstrated by lack of change in these cells in laboratory tests. Therefore, it is felt that the effectiveness of treatment with ribavirin remains unproven. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, AIDS research, Ribavirin, editorial

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Neuropsychological investigation of patients with AIDS and ARC

Article Abstract:

Over the course of infection with HIV (human immunodeficiency virus), 40 percent of patients experience neurologic complications. These may involve cognitive (mental) as well as motor and sensory functions. A common syndrome is known as AIDS (acquired immunodeficiency syndrome) dementia complex, which begins with development of a subacute encephalitis, an inflammation of the brain, and is characterized by impaired memory and concentration. In this study, 34 homosexual men were evaluated for cognitive impairment; 17 had AIDS and 17 had ARC (AIDS-related complex). Most of the patients with ARC and about half the patients with AIDS complained of poor memory. Depression was diagnosed in one AIDS patient and three ARC patients. A broad spectrum of cognitive functions was assessed, including intellectual ability, memory and learning, visual-graphic and visual-constructive ability, mental and visual-motor tracking, abstraction, conceptual flexibility, and ability to analyze complex information and implement adaptive responses. All patients showed signs of cognitive impairment consistent with dysfunction of the brain, but none showed signs of severe dementia. The deficiencies observed were in the areas of recent and delayed memory and learning, generalized cognitive slowing, and reduction in mental flexibility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Usage, Complications and side effects, AIDS patients, Neuropsychological tests, AIDS-related complex

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Current status of clinical trials in HIV disease in Australia

Article Abstract:

Australia's National Centre in HIV Epidemiology and Clinical Research has played a central role in organizing clinical trials on anti-HIV drugs and opportunistic infections and cancers. Through this organization, Australian patients participated in two international studies demonstrating the effectiveness of the drugs zidovudine and acyclovir. The National Zidovudine Open Label study further confirmed zidovudine's efficacy and also resulted in two other studies that demonstrated the usefulness of CD4 cells and p24 antigen as markers of HIV activity. Early on, most HIV trials were conducted by the pharmaceutical industry with little input from major hospitals, but a network of more than 20 hospitals and outpatient care centers has developed, contributing a significant amount of data to more recent studies. While most of the major studies conducted in Australia have been part of international groups, the organization's expansion has fostered the development of smaller local studies on Kaposi's sarcoma and non-Hodgkin's lymphoma.

Australia, Drugs, Testing, Clinical trials, HIV infection, HIV infections

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