Time to hit HIV, early and hard

Article Abstract:

Early treatment of HIV-1 infection with aggressive therapy is favorable. One 1995 study showed that zidovudine treatment of asymptomatic HIV infection does not delay the onset of AIDS or death. Another 1995 study showed that zidovudine treatment during primary infection of HIV-1 reduced the development of symptoms and increased the CD4 cell count. The seeming contradiction of these two studies can be explained by how HIV-1 infection develops. In the early stages of infection, the virus multiplies at a high rate with little variation, thus antiviral drugs have a greater impact. During the asymptomatic stages the virus does not multiply as rapidly, so drugs may not be as effective. In the later stages of infection huge numbers of variations of the virus that are drug resistant have developed. At this stage, treatment with one drug will not be effective. Because powerful antiviral drugs do not yet exist, it is difficult to establish when the best time of treatment is. However the development of new drugs also favors early treatment.

Editorial

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A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection

Article Abstract:

The protease inhibitor ritonavir may be effective in reducing the level of HIV-1 in the blood and increasing CD4 counts in HIV-infected people. Fifty-two HIV-infected people with CD4 counts between 50 and 500 and a viral RNA load of at least 25,000 copies of HIV-1 RNA per milliliter of plasma received ritonavir or placebo for four weeks, and then all the participants received ritonavir for eight weeks. Dosages varied from 600 milligrams a day (mg/day) to 1200 mg/day. After 12 weeks, the level of viral RNA in blood plasma decreased by an average of 0.50 log in the ritonavir group and did not change significantly in the placebo group. A more sensitive test found the decrease to be 1.1 log with ritonavir. The viral load had been lower at 4 weeks and then had begun to rise again. After 12 weeks, the median increase in CD4 count was 83. Almost all of the participants experienced side effects including nausea, diarrhea, headache, and numbness in the mouth.

Protease inhibitors

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A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome

Article Abstract:

The antibiotic clarithromycin seems to be effective in preventing Mycobacterium avium complex infections in AIDS patients. Of 677 AIDS patients with no history of this opportunistic infection, 333 began taking clarithromycin and 334 began taking a placebo. Only 19 (6%) of those taking clarithromycin developed the infection, compared to 53 (16%) of those taking placebo. Clarithromycin reduced the mortality rate by 25% during the 10-month follow-up. Eleven of the 19 patients taking clarithromycin who developed the infection had a drug-resistant strain.

Mycobacterium avium complex, Mycobacterial infections, Mycobacterium infections, Clarithromycin

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