AIDS TREATMENT GUIDELINES REVISED
By Anthony J. Brown
Reuters 2 February 2001
New York -- Revised AIDS treatment
guidelines call for delaying antiretroviral therapy in patients who
have no symptoms, US government researchers will announce Monday. The
new recommendations aim to reduce the toxic effects of the powerful
drugs HIV-infected people take to fight the virus.
"The philosophy of the original guidelines was to hit hard and hit
early,'' Dr. Anthony Fauci, director of the National Institute of
Allergy and Infectious Diseases (news - web sites), told Reuters
Health Thursday. "That philosophy was reasonable if you assumed that
antiretroviral therapy could eradicate the virus and ultimately get
people off therapy.''
However, Fauci explained, since clearing the virus completely is not
currently possible, people will likely need to keep taking their
medicines indefinitely. "This shifts the risk-benefit ratio to
looking at the long-term toxicities of treatment,'' he said.
"If you look at people who have been treated for many years, there
is an increasing incidence of toxicities...and emergence of resistant
organisms,'' Fauci added.
The hallmark of HIV infection is damage to the immune system.
Dropping levels of a type of white blood cell called CD4+ cells is a
sign doctors use to monitor this destruction.
Previously, antiretroviral therapy was recommended for symptom-free
patients who had 500 CD4+ white blood cells per microliter of blood,
or 10,000 copies of the virus per milliliter of plasma according to a
measurement called branched-DNA testing.
The current revision calls for delaying treatment until the CD4+ cell
count is less than 350 cells/microliter, or the viral load is greater
than 30,000 viral copies by branched-DNA testing. In essence, "we
are setting the bar at a more advanced stage of disease,'' Fauci noted.
Current research suggests that delaying treatment in this way will
not impact survival or time to development of an AIDS-defining
illness, Fauci pointed out. But this delay may help reduce the
incidence of the toxic cumulative side effects linked to the
"cocktail'' of drugs HIV patients take.
Fauci emphasized that the treatment revisions were for asymptomatic
patients only. Guidelines for patients who have symptoms, or whose
CD4+ cell counts are less than 200 cells/microliter have not changed.
The revised guidelines, a joint effort of the Department of Health
and Human Services and the Henry J. Kaiser Family
Foundation, will be released on February 5.