European Association of Nurses in AIDS Care
8th Annual Conference - AD 2000: Advances in AIDS Care, September 1997
Key points of session:- Advances in HIV Therapy - Anton Pozniak
Notes taken and webplaced by Ian Hodgson on 22.10.97
- picture is changing rapidly !
- cost of antiviral treatment approx. £7500 per year
- antiviral drugs are not available in most parts of the world where HIV appears
- doubling time of HIV = 2 days - between 60m and 1.8bn viral particles produced in 1 day, and therefore there is much potential for mutations and resistance
- definitions: viral load = number of particles per cubic mm; aim of antiviral treatment is to reduce plasma viral load to as low a level as possible, and keep it there for as long as possible (ideally not detectable on usual assay test) - thus improving clinical outcome
- viral load is related to survival - a count of 30000 means a person is 18 times more likely to die than a count of less than 500
- when to start ? - UK when CD4 count is 350; USA CD4 count of 500
- single drugs allow for resistance due to speed of viral replication (can't keep up)
- 2 drug effective initially, but viral load soon climbs (especially in 'drug experienced' people)
- addition of third drug (protease inhibitor - works by denying the virus material to replicate) is highly effective, though has side effects (eg. redistributes fat) which can be unsightly
- important to assess treatment history of person to ensure a non-resistant drug is given - then, early treatment can reduce viral load rapidly
- starting treatment = P.A.N.I.C. - polypharmacy; adverse events; new drug trials; interaction with other drugs; compliance (problem - tablets are huge) - 90% of compliant patients have viral load of <200, whereas only 60% of non-compliant patients achieve this
- combination therapy is effective, but must be tailored to individual; compliance meust be maximised; treatment should be given according to viral load, not CD4 count; if viral load climbs, change treatment