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Patients with HIV live longer but face new challenges
Reported by Jules Levin
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In this press release from the organizers at the conference researchers say
HIV is becoming a chronic manageable disease, but body changes and other
complications are increasingly difficult to manage. Fat loss in the face,
limbs, and buttock, and fat gain in the breats for women and belly for men is
a real concern for patients and doctors. Research into the causes and
possible interventions to address this problem is receiving much attention
but so far not much progress has been made. The body changes and difficulties
in therapy adherence have necessitated delaying the initiation of HAART.
Metabolic abnormalities are associated with HIV and therapy, and this
includes increases in cholesteral, triglycerides, and sugar, which may lead
in increased risk for premature heart disease and increased rates of diabetes
or insulin resistance. In addition, HIV-infected individuals are suffering
with bone loss. Another major concern is coinfection with HIV and hepatitis
C. It's estimated that 60-90% of individuals in the US infected with HIV by
IV drug use also have hepatitis C, and 30% of all HIV-infected individuals in
the US also have HCV. This amounts to 300,000 persons in the US which are
epidemic proportions. Studies show HIV accelerates HCV progression by 2-4
fold leading to risk for acceleration to cirrhosis and severe liver disease.
Adequate testing and treatment protocols are required in HCV/HIV coinfection.
However, there is little in the way of natural history studies in
coifection, and little Federal money is devoted to HCV testing and
prevention. In addition, there are tremendous gaps in funding to address the
specialized needs of persons with HI/HCV coinfection: case management,
prevention, access to treatment and diagnostic testing.
Advances in HIV treatment have dramatically increased life expectancy.
However, while people are now living longer with HIV, they and their
physicians are facing a new set of challenges. This has been a key message
from the Sixth International Congress on Drug Therapy in HIV Infection, held
from 17-21 November at Glasgow¹s Scottish Exhibition and Conference Centre
(SECC).
A panel comprising Ian Weller (Chairperson of the Scientific Committee, UK),
Core Committee members Peter Reiss (the Netherlands) and Eric Sandström
(Sweden), and Robert Munk (Scientific Committee Community Representative,
USA) discussed this and other highlights at the official press conference
today.
Recent HIV conferences have often reported the large reduction in HIV-related
mortality that has occurred with the use of modern treatment regimens (known
as highly active antiretroviral therapy, or HAART). This notable success
brings new hurdles to overcome. What was once a rapidly fatal disease is now
a chronic infection, with patients taking life-long therapy. Since all drugs
are associated with some degree of side effects, it is crucial that
physicians are able to understand, and therefore manage, these conditions so
that patients can enjoy a reasonable quality of life. Safety was a key topic
at this meeting. Advances were reported in our understanding of certain
conditions such as changes in body-fat composition - which is thought to be
at least partially related to treatment - but there was controversy over its
exact nature. Delegates also heard the experience of Arjen Broekhuizen from
the Netherlands, who has lived with HIV for almost 20 years. He acknowledged
that HAART has extended his life but emphasised that it has been a "hard
life" because of drug side effects.
Peter Reiss and Robert Munk commented that the management of HIV infection as
a whole is becoming increasingly complex, with physicians being expected to
understand a bewildering array of tests and data to deliver the optimal
treatment for their patients. Thus, drug resistance testing, therapeutic drug
monitoring, and ways of monitoring the HIV virus and its effects on the body
are all now commonplace. A multidisciplinary approach has become essential
for success, with physicians, nurses, counsellors, laboratory specialists and
the patients themselves working together to achieve the best results. This
can be seen as a natural evolution since, more than any other illness, HIV
has always been based on a partnership between the doctor and his/her
patient.
This team approach has also been evident at the Congress, with specialists
from many disciplines interacting with community representatives and the
pharmaceutical companies. Eric Sandström commented on the increasing interest
in, and commitment to, HIV management in resource-poor areas that has become
apparent at the Congress. Until now, the immense scale of the HIV epidemic in
regions such as sub-Saharan Africa appeared insurmountable. However, in a
keynote presentation, Michel Kazatchkine, head of the French national HIV
research agency, explained that we have reached a turning point, and that HIV
treatment must now be made more accessible in resource-poor settings. This
was supported by a series of presentations showing how such regions are
beginning to develop their own effective approaches to the problems caused by
resource scarcity. Elly Katabira (Uganda), Ernest Ekong (Nigeria), and Ernest
Darkoh-Ampem (Botswana), explained how they have been able to reach many
people through appropriate HIV treatment access programmes. While the
contribution of Western organisations and pharmaceutical companies to these
programmes is acknowledged, it is clear that the countries themselves lie at
the heart of the solution.
"Despite the challenges of drug resistance, side effects and difficulties in
adherence to therapy, the Congress has been characterised by a sense of
optimism," commented Ian Weller. "The goal of life-long suppression of the
virus is no longer unrealistic." Many new drugs are progressing rapidly
through the development pipeline - from improved versions of existing types
to whole new classes, such as the HIV entry and integrase inhibitors.
Moreover, while the number of effective options to combat the HIV virus is
increasing, we are slowly but steadily learning how to get the best out of
available drugs.
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