AIDS THERAPY GUIDELINES CHANGED
Recommendations call for later initiation of anti-HIV drugs
AP 31 January 2001
Washington — New guidelines for the use of antiretroviral
AIDS drugs call for starting the therapy later in the course of the
disease for patients who show no symptoms. The guidelines, still
being fine-tuned, recommend waiting until patients have higher levels
of virus in their blood and lower levels of white blood cells before
starting treatment with a powerful combination of drugs.
Dr. Anthony Fauci, director of the National Institute of Allergy and
Infectious Diseases, said Wednesday the change is being recommended
because it is now recognized that HIV-infected patients may have to
take anti-HIV drugs permanently.
The revised guidelines are being developed by a committee that is a
joint effort of the Department of Health and Human Services and the
Henry J. Kaiser Family Foundation. The guidelines are the distilled
recommendations of HIV experts, intended to help doctors and HIV
patients make treatment decisions.
When the guidelines were first drawn up, it was hoped that the HIV
antiretroviral therapy would be only temporary, and the drugs
eventually would eradicate the virus in the patients. There was
little worry that patients might develop toxicity reactions to the
drug, because it was generally believed its use would be limited.
“The idea was to hit it hard and hit it early,” Fauci said Wednesday.
Now research has shown that the drugs do not eradicate the virus but
merely hold the disease in check. When drug therapy is stopped, the
virus tends to spread rapidly. This means that to control the virus a
patient may face a lifetime taking the drugs, and such long-term use
causes the toxicity risk to become a major possibility.
Fauci said long-term use of the antiretroviral drugs causes some
patients to develop “sky-high” total cholesterol readings and to
develop heart disease at an early age.
Additionally, long-term use can result in a patient’s virus
developing a resistance that makes the drugs no longer of value.
Hit Hard, But Later
Fauci said the new drug guidelines still recommend to “hit it hard,”
but later in the course of the disease.
Formerly, the guidelines recommended starting antiretroviral
treatment in HIV patients who had no AIDS symptoms when CD4 cell
counts drop below 500 cells per cubic millimeter. The new guidelines
call for therapy to start when the CD4 count has dropped to 350 cells
per cubic millimeter.
CD4, or “helper T-cells,” are white blood cells that are the primary
target of HIV, the virus that causes AIDS. These cells decrease
steadily with the advance of disease. A patient with low levels of
these cells are at high risk of contracting infections that normally
would be controlled easily by the immune system.
The new guidelines also change the therapy starting point based on a
measure of the number of HIV virus particles in the blood stream.
Earlier guidelines called for drug therapy to start when the viral
load reached 10,000 viral copies per milliliter of plasma, based on
the branched DNA test, or 20,000 viral particles using the RT-PCR
New guidelines call for delaying drug therapy until the viral
load gets to 30,000 in the branched DNA test, or 55,000 viral copies
in the RT-PCR test. This means that the therapy would start later in
of the disease.
The branched DNA test and the RT-PCR test are different methods of
measuring the level of virus in the bloodstream.