BACK OFF A BIT ON HIV DRUGS,
By Maggie Fox
Reuters 18 Jan. '01
Washington -- AIDS experts are backing
off from their philosophy to hit the disease as early and as hard as
possible, now that they realize they cannot kill the virus outright,
a top government health official says.
They will release new treatment guidelines that suggest backing off a
bit and not giving patients strong drug cocktails until they really
"We are being a little bit more conservative in our recommendations
of when to start,'' Dr. Anthony Fauci, head of the National Institute
of Allergies and Infectious Diseases (NIAID), said in a telephone
"Now we are saying you might want to start treating at a little bit
lower CD4 count and a little higher viral load.''
When HIV drug cocktails first came out, doctors debated whether
patients should start taking them right away or wait until they were
really needed. Many studies were done comparing various combinations
and start times.
For a while it was hoped that if the virus could be kept dormant for
long enough, it would die off in the body. The cocktails, when taken
precisely, do suppress the virus.
But in recent years it has become clear that HIV can hide out in the
body for decades, even a lifetime, and that it may even continue a
low level of replication despite the drugs.
"We know that you are not going to eliminate, you are not going to
eradicate the virus,'' Fauci said. "What we can do is control it
And it has also become clear that the drugs, while keeping patients
alive and well, can have serious side-effects. These range from
nausea and diarrhea to long-term metabolic changes that may put
patients at risk of heart disease, diabetes and bone loss.
"We have been observing, as others have for the past couple of
years, that there is a cumulative toxicity with some of these drugs,''
"We need to allow a degree of flexibility because we don't know what
the long-term toxicity will be.''
The AIDS cocktails and a patient's response to them have to be
monitored very carefully. Terms such as "CD4 count'' and "viral
load'' refer to how much virus there is circulating in the blood and
how badly it has damaged the immune system.
Fauci said the new guidelines, to be released in detail next month at
an annual scientific meeting of HIV experts in Chicago, will mean
tolerating a bit more virus in the body in return for sparing the
patient the side-effects and inconvenience of the drug regimens.
But once the drugs are prescribed, they should be taken in full force.
"Once you start, then you really should hit hard,'' Fauci, whose
institute at the National Institutes of Health helps lead AIDS
And one very small group of HIV patients is not included in the new
guidelines -- those whose disease is caught within days of infection.
Studies suggest that if they get treatment right away, their immune
systems might remain strong enough, and might be trained, to fight
the virus on their own.