Salvage conference highlights
by Enid Vázquez
The 3rd International Workshop
on Salvage Therapy for HIV Infection was held in Chicago in
April. It’s when you hit that third group of drugs that
you’re considered to be on “salvage” therapy.
(The second combination of meds is being called the “second-line
regimen.”) Following are highlights from the conference.
LAC improves neuropathy
Let’s start with side
effects—the reason many regimens fail in the first place.
A tiny study of four people taking 1,500 mg twice a day of
L-acetyl carnitine (or LAC, not to be confused with regular
carnitine supplements) found it improved their peripheral
neuropathy. Patients reported relief in symptoms of numbness,
tingling and pain in the hands and feet caused by this common
HIV condition. (The symptoms don’t sound like much, but
neuropathy tends to be extremely painful and permanently disabling.)
The self-reported improvements were confirmed by laboratory
testing. One person was even able to stop taking narcotic
painkillers after several months on LAC (the average time
it took for people to see improvements). The only side effect
noted was mild diarrhea. Dr. Michael Youle and colleagues
from the Royal Free Center for HIV Medicine in London conducted
this trial to follow up on another small study finding neuropathy
improvement with LAC. There are now about 60 people in the
clinic taking the drug.
See an HIV specialist
Two reports confirmed earlier
findings that the more HIV patients doctors have, the more
experience those doctors have, and the better their patients
do. HIV is a complicated disease that’s best not left
to amateurs.
The Norvir boost
The odious little drug
(okay, lots of people take it without trouble, but it’s
infamous for nausea, diarrhea and regurgitation) looks pretty
good in small amounts for boosting the levels of other protease
inhibitors. The conference organizing panel ended up deciding
they want to see more data before determining Norvir’s
usefulness for this job. Naturally, since doctors like to
be careful. Because low-dose Norvir is getting so popular,
even observational databases would be helpful, they said.
What they saw here was that
800 mg of Crixivan boosted by 200 mg of Norvir—both given
twice a day—resulted in half the people on this salvage
regimen measuring undetectable (using 400 copies viral load)
at 12 weeks. The 41 men had previously taken an average of
three protease inhibitors and on average had gone through
six regimens. Their median starting baseline viral load was
30,015 and median T-cells was 258. The results are from a
retrospective chart review and not as scientifically strong
as would be found in a controlled clinical trial. Also, the
number of participants is small and the results short-term
(48 weeks is ideal). There were two drop-outs, one due to
hair loss (Crixivan, undoubtedly) and one to nausea/vomiting
(Mr. Odious, himself, undoubtedly). Good news is there are
no food restrictions as there generally are with Crixivan
alone, but you still need to drink lots and lots of water
to avoid painful kidney stones.
Norvir also helps people
manage to take Agenerase protease inhibitor with Sustiva,
a non-nuke. Otherwise, the two drugs shouldn’t be taken
together because Agenerase levels are greatly lowered. Jean-Louis
Vilde and colleagues, from Paris, prescribed Agenerase at
450 mg and Norvir at 100 mg, both twice daily, with Sustiva
at its standard dose of 600 mg once a day (three capsules).
The standard dosing of Agenerase horse pills (they may be
soft-gelatin capsules, but that doesn’t help much) is
1,200 mg twice daily. Viral load results were good in the
seven people taking the five-drug regimen (including two nucleoside
analogs, such as AZT).
TDM
Therapeutic drug monitoring
(TDM) is expected to become the next big test for HIV. It
measures your blood levels of different drugs. However, there
are lots of complications that need to be figured out. It
is also still experimental for HIV (but used in other diseases).
According to HIVandHepatitis.com,
Dr. Richard Hoetelmans from Slotervaart Hospital in Amsterdam
made the following points during an oral presenation on TDM:
there is good predictability between protease inhibitor blood
levels and undetectable viral load for salvage patients, but
not for people taking meds for the first time (however, he
expects that to change so that you can predict success in
this latter group, as well); it’s the opposite for the
non-nukes—you can predict success for the so-called “treatment
naive” group (the first-timers), but not for the non-nuke
experienced; and there is no association at all for the nukes
(the AZT class of drugs).
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