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Biotech / Medical : Agouron Pharmaceuticals (AGPH) -- Ignore unavailable to you. Want to Upgrade?

To: Steve Fancy who wrote (4823)	7/8/1998 10:17:00 PM
From: Oliver & Co	Respond to of 6136

"Antiretroviral Therapy for HIV Infection in 1998" Journal of the American Medical Association (07/01/98) Vol. 280, No. 1, P. 78; Carpenter, Charles C.J.; Fischl, Margaret A.; Hammer, Scott M.; et al. ÿÿÿÿ The International AIDS Society-USA Panel has issued its updated recommendations for the treatment of HIV through mid-1998.ÿ The authors state that there is no defined optimal treatment initiation period, but that there is a growing consensus that early treatment initiation is associated with virologic, immunologic, and clinical benefits.ÿ The panel recommends that patients with an established HIV infection and a plasma HIV-1 RNA level greater than 5,000 to 10,000 copies/mL receive antiviral treatment, provided the patient is committed to regimen adherence.ÿ The panel suggests the initial use of regimens that will suppress the virus to undetectable HIV RNA plasma levels using the most sensitive assays.ÿ Other approaches may increase the risk of drug-resistance development and limit future treatment options.ÿ Primary consideration should be given to the use of a protease inhibitor in combination with two nucleoside reverse transcriptase inhibitors.ÿ The use of non-nucleoside reverse transcriptase inhibitors is a reasonable alternative, but physicians should consider the potential for drug-resistance and drug-interactions with some protease inhibitors.ÿ The panel notes that protease inhibitor choice should be based upon maximum in vivo potency.ÿ The panel's recommendations for the modification of therapy due to treatment failure, adverse effects, intolerance, and nonadherence have not been altered.ÿ Treatment failure should be defined as detectable levels of HIV RNA in adherent patients using the most sensitive assays.ÿ Clinical success observed in conjunction with treatment failure may be of concern, since sub-maximal suppression of the virus may result in the development of drug-resistant strains.ÿ The appearance of long-term adverse effects does not mandate a change in treatment when a positive response is achieved.ÿ Additionally, therapy should be maintained as long as possible.ÿ For special considerations, the panel suggests the immediate initiation of therapy when primary HIV infection is identified.ÿ Treatment of pregnant HIV-infected patients is the same in most respects as of non-pregnant patients; however, women who are diagnosed with HIV and pregnancy simultaneously may wish to postpone treatment until the second trimester.ÿ Postexposure prophylaxis has been shown to be beneficial in HIV-exposed health workers, and initiation of combination treatment with antiretrovirals is recommended for high-risk occupational exposure.