News (Updated August
28, 2011)
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Michael Carter
24 August 2011
“This is a remarkable
accomplishment that is probably due to improved antiretroviral drugs and changes
in management, including the starting of therapy at less advanced
immunosuppression,” comment the authors.
They add that the levels
of HIV suppression achieved by their patients could have important implications
for the prevention of further HIV transmissions.
Triple-drug antiretroviral
therapy first became available in 1995-96. However, it was based on unboosted
protease inhibitors that lacked potency. Treatment also had other limitations.
It often involved unpleasant side-effects, adherence was difficult, and many
patients had pre-existing resistance due to a history of previous therapy
involving only one or two anti-HIV drugs.
Since then there have been
major improvements in HIV treatment and care. These have included the
introduction of boosted protease inhibitors and potent NNRTIs, as well as the
development of drugs in new classes. Indeed, the goal for HIV treatment for most
patients is an undetectable viral load. Moreover, there have also been changes
in treatment guidelines, which now recommend the early initiation of
antiretroviral therapy.
Johns Hopkins’ HIV
clinic serves a large socially disadvantaged urban population. Between 1996 and
1998 only 44% of the clinic’s patients taking HIV therapy achieved an
undetectable viral load, but by 2001 to 2002 this had increased to 79%.
Investigators from the
clinic wanted to see how changes in HIV treatment and care had impacted on their
patients’ viral load between 1996 and 2010.
A total of 5290
individuals were included in the investigators’ analysis.
There were important
changes in the demographics and clinical characteristics of the patients over
the period of the study.
Their median age increased
from 38 years in 1996 to 49 years in 2010. There was also a marked fall in the
proportion of patients who were infected with HIV via injecting drug use, from
46% in 1996 to 36% in 2010. At the same time, there was an increase in the
percentage of patients who acquired HIV through heterosexual intercourse (43% to
51%).
The proportion of patients
taking triple-drug antiretroviral therapy increased from 22% in 1996 to 85% in
2010, and overall CD4 cell count increased from a median of 239 cells/mm3 to 444
cells/mm3.
Median viral load fell
from 10,000 copies/ml in 1996 to below 200 copies/ml in 2010. Moreover, by 2010,
only 17% of patients had a viral load above 500 copies/ml.
Rates of retention in care
improved from 86% in the period 1996 to 2002 to 94% by 2010.
“We believe that our
results emphasize that even an inner urban HIV-infected population with a
relatively high proportion of patients who were infected as a consequence of
injecting drug use, HAART [highly active antiretroviral therapy] can be highly
efficacious,” write the authors.
They add: “These
results…reflect the increasing use of HAART and are a testament to the
remarkable effectiveness of HAART in our patient population.”
There is considerable
interest in the use of HIV treatment as prevention, and the investigators
believe that the viral suppression achieved by their patients “may…have
implications for transmission of HIV in the urban community which the Johns
Hopkins HIV clinic draws its patients.”
An editorial accompanying
the study is equally enthusiastic about its findings, the author commenting,
“the results of the study are highly relevant for clinicians, because they
show an extremely high treatment success rates, even in the context of
challenging sociodemographic circumstances. Providers faced with potentially
difficult cases can be reassured that most of these cases are in patients who
will achieve virologic suppression with the effective and well-tolerated
regimens now available.”
Reference
Aug 25, 2011
MUMBAI Aug 25 (Reuters) -
Indian drugmaker Cipla expects to meet domestic industry growth of 14 percent
this year, its chairman said on Thursday, but warned of a possible slowdown in
its business in Libya, Syria and Algeria due to the political situation in those
nations.
"There has not been
major impact on the overall
The Mumbai-based firm,
which enjoys the highest share in
(Reporting by Kaustubh
Kulkarni; Writing by Henry Foy; Editing by Clarence Fernandez)