Viramune decreases Viracept drug levels, requiring a 1000 mg, dose, three times a day.
But I have found the combination of Combivir, Viramune, Viracept excellent & well tolerated.
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From HIN
September / October 1997 ISSUE NO. 30
"HIV News Briefs"
Report Finds State ADAPs Cutting Back
A new study conducted by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network reveals that 22 states have imposed emergency restrictions to limit either the number of people served by ADAP or the availability of the medications themselves. Some states have set ceilings on the amount spent for each patient's treatment, while others have limited the number of people who can enroll or receive protease inhibitors. The study, for the Kaiser Family Foundation, also found that most states cover some of the drugs that can be used in combination drug treatments, but only New York and North Carolina cover all the available protease inhibitors and other antiretrovirals. At least 10 states lack the funding to provide AIDS drugs to their current patients for the entire year.
AIDS Deaths Drop 19% in United States, in Part From New Treatments
Officials from the CDC reported in July that AIDS deaths in the United States continue to decline. The number of deaths fell 19%-to 30,700 from 37,900-in the first 9 months of 1996 compared with the same period in 1995. The decline was attributed, in part, to greater access to medical care and to the development of new drugs, such as protease inhibitors, for the treatment of AIDS and AIDS-related infections. "We have entered a new era in the HIV epidemic, both in terms of treatment and prevention," said Dr Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention. Deaths of women dropped by 7%, while deaths among men fell 22%. Among racial groups, the number of deaths dropped 28% for whites, 16% for Hispanics, and 10% for blacks. Dr Gayle noted, however, that "new AIDS cases are now increasing most rapidly among women, particularly minorities," and that heterosexual HIV transmission is the fastest-growing mode of transmission. Men have 80% of current AIDS cases, while 20% are among women. AIDS cases and AIDS deaths are on the rise worldwide. Experts say that the drug "cocktails" that have helped lower death rates in the United States will probably not have the same impact in Asia and Africa, where the disease is spreading because of the high cost and complexity of treatments.
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Protease Inhibitors for the Homeless
Writing in the July 2 issue of the Journal of the American Medical Association, researchers from the University of California at San Francisco and San Francisco General Hospital assert that standard protease inhibitor therapy should be made available to the homeless and marginally housed. Between 8.5% and 20% of this population is HIV positive, and many have a history of mental illness, alcohol use, and drug use. Adherence to treatment, drug resistance, and cost are the primary reasons for caution in prescribing protease inhibitors. However, the researchers point out that adherence is just as much system related as it is person related. Clinics should, therefore, be located in convenient places, even providing transportation when possible. They should also have flexible scheduling and safe places to store the drugs. Stabilizing the patient's life-with regular medical care, housing, and drug treatment-is also beneficial. Not all homeless individuals are unreliable, and many who are HIV infected are already in regular contact with the medical system. Drug resistance should be monitored closely at the population level, because development of resistance in new seroconverters could have important public health implications. The researchers also note that management depends on the patient's CD4 levels and purified protein derivative (TB) skin test status; treatment to prevent TB and PCP should be a priority.
Source: CDC National AIDS Clearinghouse. Copyright 1997, Information, Inc., Bethesda, MD.
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