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1st appeared
29 September
1999 HIV Patients Still Vulnerable to Opportunistic Infections Despite the effectiveness of antiretroviral drugs, HIV patients are still very vulnerable to opportunistic infections, according to new research by AIDS specialists at UCSF. This vulnerability has important implications for developing optimum treatment strategies, the researchers emphasize. In presentations at the Interscience Conference on Anti-Microbial Agents and Chemotherapy in San Francisco on Monday, the researchers reported study findings on two different infections common in HIV patients and how they relate to highly active antiretroviral therapy, known as HAART. There is only limited information on the impact of HAART on AIDS-related opportunistic infections because it is still a recent treatment approach. Initiated three years ago, HAART uses a combination of powerful drugs, including protease inhibitors and reverse transcriptase inhibitors, to subdue HIV infection and give the body the chance to increase its supply of infection-fighting CD4+ T-cells that are destroyed by HIV. One of the new research reports focused on the incidence of cytomegalovirus (CMV) retinitis, a serious eye disease that can lead to blindness. The second looked at development of drug resistance in the respiratory tract of HIV patients who underwent prophylaxis therapy to prevent a bacterial infection caused by Mycobacterium avium complex (MAC), which causes serious illness that ultimately leads to wasting and death if untreated. Findings from the CMV research were both good and bad, said Mark Jacobson, lead investigator and a UCSF associate professor of medicine who treats patients at San Francisco General Hospital Medical Center. "On the positive side, the incidence of CMV retinitis in the HIV population is now 25 percent of what it was in the pre-HAART era, and we’ve seen no increase in this rate since HAART became available. The disturbing finding, however, is that among new retinitis cases, about 50 percent are occurring in patients who have failed to respond to HAART. Thus, we need to continue investigating the factors that lead to CMV retinitis," he said. In the second study on MAC prophylaxis, researchers looked at the development of resistance to two antibiotics, clarithromycin and azithromycin, that belong to a class of drugs called macrolides. In addition to being used to prevent MAC infection, both drugs commonly are used to treat respiratory infections unrelated to MAC in all types of patients, not just the HIV population. Study results showed that the bacteria normally present in the respiratory tract of HIV patients developed high-level resistance to the antibiotics within six weeks of starting prophylaxis. According to lead investigator Judith Aberg, the study results have key implications for determining optimum HIV treatment during the current HAART era. Respiratory infections are the leading cause of death among AIDS patients, and macrolides are frequently given as first line therapy. They may not be effective, however, in patients who have previously had treatment with this class of drugs. Patients who are responding to HAART may be doing well enough that they don’t need prophylaxis, she said. Links: Related stories: Immune System Responds to Infection After Aggressive HIV Therapy, Study Finds Source: Corinna Kaarlela, News Services |
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