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  9th Conference on Retroviruses and Opportunistic Infections
Seattle, Washington, February, 2002
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9th Retrovirus Conference Highlights From Late Breakers
Reported by Jules Levin
  The Conference ended this morning with the Late Breaker session from 9-12am. Here are highlights from today which will be followed by more detailed reports.
Sam Bozzette, from the VA system reported on a study evaluating cardiovascular outcomes from over 30,000 patients in the VA system. He reported there were no increases in cardiovascular events. He concluded this data does not support a hypothesis of an association between HAART and excessive cardiovascular-related death & sickness. I think this is misleading and a disservice. They followed patients for 6 years. Other studies have found increased risks in heart related disease in the HAART era. Elevated lipids from HAART may lead to potential heart-related disease. But, certain behaviors can be a cause of heart disease and can be controlled by people: smoking cigarettes, diet, exercise, etc. can play important contributions in contributing to heart disease.
Michael Dube, from the ACTG & Indiana University, reported on a small study in 6 HIV-negative individuals who smoked cigarettes and received indinavir monotherapy for 4 weeks. He reported they did not change their diet or exercise routines. He found indinavir induces endothelial dysfunction. Endothelial dysfunction can be an early step in predicting cardiovascular disease. Endothelial dysfunction can constrict blood flow. Elevated lipids can contribute to additional risk for developing cardiovascular disease. These two potential causes for heart disease appear to have independent affects on increasing potential for heart disease.
J Sutinen and a research group from Finland studied rosiglitazone in patients on HAART with lipodystrophy. 30 patients were randomized to receive 8 mg of rosiglitazone or placebo for 24 weeks. Visceral fat and abdominal subcutaneous fat were measured using MRI. Rosiglitazone is an anti-diabetic drug that can improve insulin resistance in HIV-negative diabetics. Although insulin levels went down suggesting improvement in insulin resistance, subcutaneous fat did not improve. Waist-to-hip ratio did not improve. Increases in triglycerides were observed. ALT did not increase.
Ray Chung, from Harvard medical School and the ACTG, reported on Pegasys (pegylated interferon) + ribavirin in HIV/HCV coinfected patients. 133 patients were randomized to receive either Pegasys/ribavirin or standard interferon + ribavirin. The standard interferon dose was 6 MIU 3x/week for 12 weeks; the Pegasys dose was 180 mcg once per week. Each group received 600 mg ribavirin escalated to 1000 mg/day. The study is for 48 weeks treatment with a 24-week followup period. The baseline characteristics of the two groups were similar. Chung reported preliminary interim data at week 24: by ITT analysis, 44% undetectable HCV RNA (<60 IU by RocheAmplicor) receiving Pegasys/RBV compared to 15% receiving standard interferon/ribavirin. Most study patients were genotype 1 & high viral load. Although there were more grade 4 toxicity events in the peg group (17 vs 5), premature discontinuation was lower than might be expected and about the same in both groups (15% Peg vs 12% IFN). Multivariate statistical analysis found receiving peg interferon, being Caucasian, having low fibrosis, and a Karnofsky score less than 100 were jointly associated with viral response. Encouragingly, over a third of viral nonresponders who underwent biopsy had histologic response (improvement in liver condition). This suggests benefits can occur without a viral response, which has been seen in other studies in HCV monoinfected.
Jose Gatell, from Spain, reported on a study of 460 adults receiving PI-HAART and undetectable HIV RNA (<200 copies/ml) for 6 or more months who were randomized to switch to nevirapine, efavirenz or abacavir. Gatell reported baseline characteristics did not differ between the 3 treatment arms in the study. Gatell said patients with elevated cholesterol & triglycerides who switched to abacavir saw improvements, while those who switched to nevirapine or efavirenz did not. The viral response was about the same in the three switch groups with the exception that patients with prior NRTI resistance who switched to abacavir saw more viral failures. This is due to NRTI cross-resistance, as abacavir is an NRTI. The proportion of patients with cholesterol over 240 at the end of the 48-week study was lower in the abacavir arm than the efavirenz and nevirapine arms.
These are brief highlights. More detailed reports to follow in extensive coverage of Retrovirus from NATAP's team. Sleepless in Seattle, Jules Levin