Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the past two years, two new classes of drugs have emerged that are effective in treating HIV infection. Since protease inhibitors and non-nucleoside reverse transcriptase inhibitors are highly effective but difficult to take, pharmaceutical manufacturers have developed new formulations of some of these drugs. People taking AZT and ritonavir can sometimes switch to a product called Combivir, a combination of the two. Saquinavir patients may be able to switch to a gel formulation of the same drug, Fortovase, that is more readily absorbed by the body. Potential side effects and impacts on treatment are reviewed.
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PMID:New ways to take old drugs. 1136 12

Most patients on protease inhibitors who plateau at viral loads within quantifiable levels must switch to an alternative or salvage therapy to continue to decrease these loads and maintain some form of antiviral therapy. The Public Health Service Guidelines suggest using a different therapy if a particular therapy does not substantially lower viral loads to below quantifiable levels within four to six months. Physicians and researchers at the International Workshop on Salvage Therapy for HIV Infection advocated progressively switching patients to a more suppressive regimen to give them a better chance of long-term success. However, if a patient has a stable viral load or there is only a short-term benefit from switching early in therapy, then using a salvage therapy may not be warranted. Results from salvage therapies used for saquinavir failures are mixed. As with nelfinavir, subsequent regimens for patients failing indinavir have a better chance of success when implemented early in treatment. Saquinavir and nelfinavir combined seem to get better results when administered with two reverse transcriptase inhibitors. Use of new experimental drugs as a secondary therapy have mainly short-term benefits and conflicting side effects. Dr. Keith Henry of Regions Hospital in St. Paul treats each case individually. Dr. Henry cautions not to aim for short-term responses and avoid using alternative treatments too quickly, leaving little recourse after viral rebound. Further clinical trials are underway and more are planned to test additional salvage protocols.
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PMID:The great salvage therapy drug juggle. 1136 98

There are a number of new developments in the fight against the HIV epidemic. New drugs are being developed, results are being reported from a number of clinical trials, and there are some new strategies in disease management. Currently, there are eleven approved medications for HIV. Several new drugs or studies are highlighted: adefovir dipivoxil (preveon), which is now available under an expanded access program; abacavir (GW1592U89, efavirenz), which shows promise as an antiretroviral ten times more effective than AZT; amprenavir (141W94, VX-478), a new protease inhibitor nearing the end of clinical trials; Fortovase (soft-gel Saquinavir), which is proving much more effective than its earlier formulation; and Hydroxyurea (HU), a long-approved anti-cancer drug which enhances the effectiveness of other HIV medications. Several drugs under development are discussed, such as ABT-378, which show great promise in the treatment arsenal.
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PMID:What's new, what's next? 1136 47

A 44-year-old man diagnosed with HIV in 1992 has become 3TC-resistant, has had adverse effects to ddI, and most likely will have the same adverse effects to d4T and ddC. The Ritonavir, Saquinavir, and Nevirapine combination he was switched to did not reduce his viral load, however, the patient was clinically stable without wasting or opportunistic infections, and his CD4 count was 220 cells/mm3. Based on past responses to medication and to the available NNRTIs, it is believed that the patient is currently cross-resistant to all first-generation protease inhibitors. It was suggested that the patient, now categorized as having virologic failure but clinical/immunologic success, is unlikely to achieve durable suppression, even with the new drugs becoming available. Mega-HAART therapy, which uses up to eight drugs, may work temporarily but appears to be intolerable in the long term for most patients. It is not known how long the patient's clinical/immunologic stability will last, but it is unlikely to continue indefinitely in the presence of high viral replication. In the case of worsening conditions, it is suggested that a phenotypic analysis be done to guide salvage therapy. In the absence of a phenotypic analysis, it is suggested to try a combination of ddI plus d4T plus Hydroxyurea plus Nelfinavir plus efavirenz.
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PMID:A patient with no options? 1136 84

Two new diagnostic tests which evaluate a patient's HIV resistance to antiviral drugs were scheduled to be on the market in July. The tests are being marketed under the trademarks Antivirogram, by Laboratory Corporation of America, and VircoGEN by VIRCO. Both companies say that when the tests are used together, they will predict which drugs a patient will respond to, leading to more effective treatment decisions. Studies were conducted to predict the effectiveness of Ritonavir/Saquinavir therapy, and the results were very promising.
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PMID:Predicting drug effectiveness. 1136 96

To augment the limited antiviral treatments available for children, new therapies to treat children are being investigated. On recommendation from Federal guidelines, many treatment regimens approved for adults are being prescribed for children, but these have little information available about dosing and long-term effects. Ritonavir in different combinations and dose levels has shown good short-term results, and it is believed that the long-term outcomes will mirror the adult outcomes. The Pediatric AIDS Clinical Trials Group study 338 indicated that the three- drug combinations used had a similar impact on viral load when compared to the adult studies. An additional study of Ritonavir, given as a salvage therapy to children with high viral loads, illustrates that pediatric trials should use the experiences learned from adult trials to formulate beneficial regimens. Descriptions of studies for children utilizing Nelfinavir, Saquinavir, and abacavir describe the triple drug combinations that were most successful, the side effects that were experienced, and the need for liquid formulations of the drugs for easier administration. Critical issues that need to be addressed are: adherence to treatment, modifications of side effects, toxicity, and appropriate dosing. A summary of current Federal guidelines for treating children and adolescents with HIV is included.
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PMID:Antivirals and children. 1136 46

Availability of clinical data on HIV and women is limited, yet women constitute the fastest growing population with HIV infection. Hoffman LaRoche has announced a study that will examine the different responses of men and women to anti-HIV therapy. The study will compare responses to the protease inhibitor Fortovase (Saquinavir soft-gel capsules) combined with two nucleoside reverse transcriptase inhibitors. Enrollment information and studies details are included.
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PMID:Are men and women really different? 1136 80

A case study is presented of a 32-year-old hemophiliac male who was diagnosed with HIV in 1985. His treatment history is discussed, including his development of symptomatic hepatitis after Saquinavir was added to his treatment regimen. Dr. Keith Henry and Dr. Donald Craven present their point of views on this case and discuss the possibility of different treatment regimens. They also stress the importance of preserving future treatment options.
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PMID:Keeping options open. 1136 95

Impotence is often associated with protease inhibitor use, but much of the medical press ignored this issue until Spanish doctors described sexual difficulties following protease inhibitor therapy in 14 of 260 patients. Causes of sexual dysfunction in HIV-infected men are difficult to isolate but may also be traced to depression, physical weakness, opportunistic infections, stress, nerve damage, or hormonal imbalances. Pfizer, the manufacturer of Viagra, released study data on the effects of the drug used in combination with Ritonavir and Saquinavir; the data led Pfizer to alter Viagra dosing recommendations for people on protease inhibitors.
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PMID:Protease inhibitors, sexual dysfunction and Viagra. 1136 2

Four protease inhibitors are compared: Saquinavir (Invirase, Fortovase), Indinavir (Crixivan), Ritonavir (Norvir), and Nelfinavir (Viracept). Key questions are answered on how dosages change when combined with nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and other protease inhibitors. Information on administration and storage and the impact of each drug on disease development are reviewed. Drug interactions between protease inhibitors and other HIV drugs and non-HIV medications are described. Side effects are also discussed. Pediatric use is addressed, including suggested dosages. Contact information for each manufacturer is provided, along with approximate annual price for treatment.
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PMID:Protease inhibitors at a glance.... 1136 98


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