Peripheral Neuropathy and more
(Feb 6th)

In this morning's talk on Peripheral Neuropathy by a leading researcher/doctor in this field, Dr Justin McArthur from Johns Hopkins, he made several key interesting points:

--CD4 and viral can predict the development of peripheral neuropathy. So starting therapy when CD4s are lower and viral load higher may influence developing neuropathy sooner.

--In talking with other docs at the conference they relate that starting therapy when viral load is high or merely high viral load in plasma may lead to developing other HIV associated neurological disorders such as dementia. This relates to the subject of when to begin therapy and is often overlooked in the current movement to defer therapy.

--McArthur also talked about how doing a skin biopsy can help in diagnosing neuropathy, thus suggesting this might be a good way to monitor a patient's development of neuropathy. This could permit changing therapy. He also talked about how neuropathy can be drug related d4T/ddI regimens may be more likely to lead to neuropathy. He suggested AZT, 3TC and abacavir may be least likely. He said CD4 count was associated with nerve fiber density, suggesting lower CD4 count may lead to reduced fiber density & neuropathy.

--As you may know, the new Federal Treatment Guidelines are being issued today and I believe they recommend therapy to be deferred to 350 CD4s and 30,000 viral load. This may be a problem for reimbursement. ADAP, Medicaid, prisons and other government programs may use this to deny therapy for persons who would like to begin therapy earlier.

This afternoon is an oral session on Treatment Interruptions, with interesting looking abstracts.

Jules Levin
NATAP