October 27, 2001
The weather has been spectacular here in San Francisco and the city seems untouched by the events of September 11. Coming from New York, it seems very far away and very normal here. That belies the conference content however. There is a great deal of talk of bioterrorism, anthrax and smallpox -- which has been added to the program, even postponing some HIV events. In addition, the FDA approved tenofovir Friday and there is some celebration at the Gilead booth. The company tells me that the drug should be in pharmacies by this Thursday, November 1. Overall there have not been a great deal of striking discoveries here, but some refinements that mean simplification of regimens and of life for patients and physicians -- a welcome concept in these troubled times.
This abstract is not completely new and has been presented before in preliminary form. It basically randomized patients who were on protease inhibitors to continue their protease inhibitors or have abacavir (ABC, Ziagen) substituted for the protease inhibitor. The idea is to avoid some of the long-term complications of protease inhibitors, which have been highlighted at the recent Lipodystrophy meeting in Athens.
These complications are usually increased cholesterol and triglycerides and insulin resistance which, in some cases can be the precursor to diabetes and body changes. This study did show that HIV viral loads and CD4s remained the same on the ABC regimen -- suggesting that nothing was lost in terms of HIV control.
In addition, adherence to medication was statistically better in the ABC group since many patients were able to simplify their regimen to two doses per day. However, there was no change in quality of life in these patients. Cholesterol and triglycerides both improved, although only LDL cholesterol (the bad one) was statistically better in the ABC group. This suggests a bright future for Trizivir (the combination of AZT, 3TC and ABC), which is one pill twice per day. The other good thing about a triple nucleoside regimen is that it saves both other classes of HIV drugs for later on. This is a reasonable strategy that I have used with good success in many patients who seem to love the idea of a simpler regimen.
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