Induction/maintenance promising with nucleoside-sparing combo

at the Annual Conference of the Australasian Society for HIV Medicine (4-7thOctober) and the Sixth International Congress on AIDS in Asia and the Pacific (6-10thOctober), Melbourne, Australia.

The discredited concept of induction-maintenance therapy for HIV infection received a boost at the Annual Conference of the Australasian Society for HIV (ASHM) Medicine in Melbourne, Australia (4-7th October, 2001) with the presentation of a 24-week pilot study by Sydney GP Dr Cassie Workman.

Dr Workman enrolled 32 patients who had fully suppressed HIV for at least six months while taking stable antiretroviral therapy, including ritonavir/indinavir (400/400 mg twice daily) plus nucleoside analogues.

Twenty-four weeks after cessation of the nucleoside analogues, 27 people had achieved sustained virological suppression with the dual protease inhibitor combination. Four individuals had viral rebound and one was lost to follow-up. Of those with viral rebound, one person had poor adherence, a second had completely stopped therapy and a third person managed to sustain undetectable viral load during a second period of maintenance therapy.

Women support pre-natal HIV testing

Dr K. Heckert of Otago University in New Zealand reported a study that compared the attitudes of health care providers regarding pre-natal HIV counselling and testing with the attitudes of women. While 96% of women supported routine offer or testing for HIV in pregnant women, only 36% of health care providers favoured routine testing. Surprisingly, only another 25% of health care workers supported routine risk assessment of pregnant women. Eighty percent of the health care providers reported that they rarely or never spoke to antenatal patients about HIV/AIDS. Dr Heckert emphasised that the reason for health care provider reticence regarding HIV testing was said to be the reluctance of women to accept HIV testing during pregnancy.

HPV smears for high risk groups

Dr Joel Palefsky of the University of California, San Francisco, called for routine HPV smear tests among groups at high risk of anal cancer, including HIV-infected gay and bisexual men.

Sexual transmission of HCV

Dr Cassie Workman of the AIDS Research Initiative, Sydney, conducted a clinic review of HCV coinfection amongst her HIV-infected patients. Twenty percent of the HCV-infected group reported sexual exposure as their only risk behaviour. Many of these individuals are linked to the leather community and/or reported fisting as a sexual practice, Dr Workman said.

New ritonavir drug interaction

Dr Workman also reported two cases of Cushing’s Disease following co-administration of ritonavir and fluticasone. Symptoms included fatigue, loss of libido, weakness and wasting, easy bruising, increased abdominal fat and ‘moon face’.

Rates of sensory neuropathy rising

Dr Catherine Cherry from the Alfred Hospital, Melbourne, reported that the prevalence of sensory neuropathy among clinic patients had increased significantly since 1993. In 2001, 60% of 140 patients had signs of sensory neuropathy and 44% had at least one objective sign. In contrast, only 14% of clinic patients had sensory neuropathy in 1993. Factors independently associated with sensory neuropathy were older age and a history of dideoxynucleoside analogues (the ‘D’ drugs).

Possible fall in rates of transmission of drug resistant virus

Dr T Middleton of the Victorian Infectious Diseases Research Laboratory reported low rates of drug resistant virus among 135 individuals diagnosed with HIV in 2000; 8% had NRTI resistance, 1.5% had PI resistance and 2% had NNRTI resistance. The proportion of this group with primary infection has not been established.