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IAC: Clinicians Urged to Consider HIV's Long-Term Complications


TORONTO -- As better antiretroviral regimens are developed, more patients infected with HIV are succumbing to fatal opportunistic infections that are the hallmark of AIDS.

TORONTO, Aug. 22 -- As better antiretroviral regimens are developed, more patients infected with HIV are succumbing to fatal opportunistic infections that are the hallmark of AIDS.

"While 30% of patients still die of HIV causes, 15% die of liver disease, 9% of our patients die from heart disease, and 8% die of malignancies," said Eric Daar, M.D., of Harbor-UCLA Medical Center in Los Angeles.

In the satellite symposium, "Mastering HIV Management," sponsored by Gilead Sciences of Foster City, Calif., in conjunction with the 16th International AIDS Conference here, Dr. Daar said that clinicians should take care to selected treatment regimens that do the least harm to vulnerable organs, especially the heart, liver, and kidneys.

"We know the benefits of antiretrovirals far outweigh the risk of heart disease," Daar said. And he said that before getting too worried about what regimen to use to protect specific organs, doctors would be wise to have HIV patients get other risk factors under control - including cessation of smoking.

At that point, he said, doctors should look at differences in treatments to determine if one drug or another is involved in increasing risks to specific organs.

For example, he cited Gilead Study 903 that compared two regimens for HIV treatment that differed only in that the nucleoside reverse transcriptase inhibitor Zerit (stavudine) was used in one combination treatment and the nucleotide reverse transcriptase inhibitor Viread (tenofovir) was used among a comparator set of patients. In that study, triglycerides were higher in the Zerit-treated patients.

Another study, Gilead 934, compared the combination Emtriva (emtricitabine) and Viread with Epivir (lamivudine) and Retrovir (zidovudine). It found the former less likely to increase triglycerides.

In the 2NN study, non-nucleoside analogs were found to depress HDLs.

Dr. Daar also noted that some antiretrovirals interact with statins, noting that Pravachol (pravastatin) and Lescol (fluvastatin) are the least likely to have interactions that affect either the cholesterol-lowering drugs or antiretrovirals.

Similarly, he reviewed studies that indicated certain antiretrovirals exacerbated conditions for persons co-infected with HIV and hepatitis C and hepatitis B. Dr. Daar said guidelines suggest the use of Viread, Emtriva or Epivir.

In kidney disease he noted that Viread is associated with a modest increase in renal dysfunction. He said that clinicians need to keep an eye on glomerular filtration rate more than creatinine levels if they want to prevent patients from going on to kidney failure.

Viread is manufactured by Gilead, which sponsored the symposium.

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