Lance Feeney reports on Project Inform’s recent HAART 2.0 Think Tank held in San Francisco in October 2008.
Project Inform recently brought some of the brightest scientists and HIV treatment activists together to explore the current and future HIV treatment landscape. The group explored three themes:
- How to help people who are already developing resistance to get onto the most recently approved drugs?
- What to do about immune system over-activation?
- What will be needed for people starting HIV therapy?
Although there were differences of opinion in each of these areas, some agreement emerged that may help people make better treatment decisions in the future. Scientists discussed new tests, which may help predict who might benefit from earlier treatment and how likely a person is to get cardiovascular disease and non-AIDS-related cancers.
Though the group differed in their thoughts about which research will best determine whether starting HIV treatment therapy earlier is a good idea, most felt we are clearly headed in that direction.
The good news is that data from many sources confirm that while current HIV treatment continues to be problematic for some, it is working far better and for far longer than most would have predicted – even in people who are heavily treatment experienced.
When to start treatment?
The trend has been towards starting at higher CD4 cell levels than previously. Data from the SMART study and other studies, suggested that people with HIV are at higher risk of death from non -AIDS related health problems (such as cardiovascular disease and cancer) if they are not on treatment with a CD4 cell count between 200 and 350. The recommended official start time was revised upwards to 350.
Conference participants debated the meaningfulness of the data and what it is telling us. Plans for a new large clinical trial called START are to begin in early 2009. This trial will determine if starting treatment at 500 CD4 cells, will lead to even less cardiovascular disease, cancers as well as fewer deaths.
What to start with?
As excited as some delegates were about the possibility of newer drugs like darunavir and reltegravir being approved for first-time treatment takers, others expressed caution, reminding the conference that there is nearly a decade of experience using current first-line therapies and that unknown side effects could eventually appear with the newer dugs. The question remains: are these drugs with their unique resistance profiles best preserved for people who are treatment experienced, or should they be available to people starting treatment to benefit from their potency -and apparent tolerability -early on?
Inflammation and HIV
There is growing agreement that persistent inflammation occurs in HIV disease, which may increase the risk of cardiovascular disease and some non-AIDS cancers. There are a number of inflammatory biomarkers to look for and it’s not yet clear which are associated with these problems. Most conference participants agreed that further research is needed to identify and prove the possible causes of inflammation, along with the biomarkers associated with it.
Multidrug Resistance
Drug-resistant HIV – including virus that has become resistant to the handful of more recently approved HIV drugs – is a constant threat. Yet, according to information presented to the conference, the number of people who have reached the end of their HIV treatment options is much lower than had been anticipated. All Think Tank attendees were aware of some people in this situation, but there was general agreement that the numbers were low and didn’t seem to be increasing quickly. However, clinical trials don’t necessarily reflect what’s happening in the real world, and activists at the conference were urged to call on labs conducting drug resistance testing to share information regarding the number of people living with HIV without effective treatment options, both now and in the future.
The numerous new drug approvals over the past two years have been extraordinary and have ultimately allowed treatment-experience patients to piece together entirely new treatment combinations to suppress their highly drug-resistant HIV.
This article has been sourced from:
Changing the HIV Treatment Paradigm – by David Evans – November 4, 2008 – POZ and AIDS Meds
To read the full article see: http://www.poz.com/articles/hiv_haart_future_401_15561.shtml [5]