Saquinavir plus ritonavir reduce viral load by 99.9 percent

A combination of two protease inhibitors, saquinavir (Invirase) and ritonavir (Norvir), may produce a median drop in viral load of 99.9 percent. Several dosage variations were tested. The most common side effects of the combination regimen included tingling around the mouth, diarrhea, fatigue, and nausea. A low level of toxicity was found. This combination may be used for people who have failed other protease inhibitor therapy or have developed a resistance to nucleoside analogues.     

Banish those side effects

Although many AIDS patients suffer side effects from their medications, not all do, and many side effects can be managed. Many patients suffer needless pain because physicians are reluctant to prescribe potentially addictive drugs. Patients may find relaxation techniques helpful in managing nausea, and should vary the use of their drugs to avoid developing an aversion to its taste. Patients should also ask for medications that can alleviate the side effects associated with some drugs.     

Understanding and treating protease paunch

The changes and complications in metabolic status and lipodystrophy stemming from HIV treatment are examined. Research results from international conferences are discussed; topics include mechanisms of action and outcomes of recent treatments for lipodystrophy. These therapies cite the benefits of diet and exercise and the use of liposuction. Also examined are studies that investigated the effects of switching HIV protease drugs. Concluding comments address the possible connection between heart disease and lipodystrophy.     

A look at lab numbers

Lab analyses show that children with HIV differ in disease characteristics from HIV-infected adults. In children, viral load and T-cells are higher initially, but gradually decline and achieve a plateau by age six. Like adults, both T-cells and two separate viral load levels must be considered when deciding on therapy. CD4+ cell counts below 25 percent of normal age levels warrant therapy. There is a substantial overlap in viral load levels in the first year of life between children who have rapid disease progression and those who do not. One study revealed that the average viral load for the first year of life was 185,000. For children below 2 years of age, viral load needs to multiply or decrease by five times to be considered a significant change, compared to a threefold difference for persons more than 2 years of age.     

Norvir capsules-soon?

Abbott Laboratories reports that it expects to put its Norvir (Ritonavir) capsules back on the market around July. Abbott reported a manufacturing problem with the capsule last year. The company cited the FDA requirements of 6-month stability data before re-introduction.     

Freedom of choice

The recent approval of three protease inhibitors introduces a welcome element of choice into HIV treatment programs. Ritonavir (Norvir), indinavir (Crixivan), and saquinavir (Invirase) all prevent HIV from replicating, leading to lower viral loads and a slower disease progression. However, patients must continue taking the drugs once they begin therapy; stopping the treatment or reducing the dosage can lead to resistance. Long term data is not yet available on toxicity or drug interactions. All three drugs are most effective when used in combination therapy.     

CMV retinitis trial expanding

Hoffmann-La Roche is expanding its trial of oral ganciclovir, which promises to be as effective as the intravenous form (Cytovene) in preventing CMV retinitis. The trial will open new sites in the United States, Canada, Europe, and Latin America. A telephone number is provided for enrollment information.     

Interscience Conference on Antimicrobial Agents and Chemotherapy. Conference update

Results from ongoing clinical trials presented at the 1997 Interscience Conference on Antimicrobial Agents and Chemotherapy are summarized. Most of the trials have not been completed, and some are still enrolling new people. The clinical trial summaries include the drug combination and dosage, number of participants, clinical notes, median viral load change, and median T-cell change.