AIDS experts in the US are about to complete a humiliating U-turn when the
Department of Health and Human Services launches its revised HIV treatment
guidelines in January.
The revisions will underline the need to hold back from using powerful
antiviral drugs until the immune systems of HIV patients show significant signs
of decline. It reflects the view, long held by British doctors, that early use
of currently available drugs may do more harm than good.
Charles Carpenter, associate director of the Brown University AIDS programme,
told a Royal Society of Medicine meeting in London last week: 鈥淚n retrospect, we
now realise the risk of drug toxicity is greatly enhanced by taking these drugs
别补谤濒测.鈥�
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For the past four years, leading American physicians have led the 鈥渉it hard,
hit early鈥� campaign which encouraged patients to take cocktails of powerful
antiviral drugs in the early stages of the disease in the hope of preventing
damage to the immune system.
British doctors were often ridiculed at conferences and in the pages of
research journals for suggesting the drugs be used more cautiously, in case they
proved too toxic for patients who take them for years or decades at a time.
Carpenter is in charge of producing the US version of the International AIDS
Society treatment guidelines. They have just fallen into line with British HIV
Association guidelines which recommend that patients should not get triple
therapy until their 鈥淐D4 count鈥濃�攖he number of T-helper immune
cells鈥攆alls to less that 350 per millilitre of blood. The normal level is
around 800 per millilitre.
鈥淭his shows that for us all medicine is a very humbling process,鈥滳arpenter
told the audience of US and British AIDS experts.
鈥淚t鈥檚 wonderful to see how after a long period you鈥檝e moved closer to us,鈥�
replied Ian Weller, head of clinical HIV research at University College London.
鈥淭he hit hard and early crowd are now hitting hard but later.鈥�
Weller, who is also deputy chairman of the Medical Research Council鈥檚 HIV
Therapeutics Trials Committee, has long voiced fears that taking a combination
of protease inhibitor and transcriptase inhibitor drugs early on in HIV disease
could do patients more harm than good.
In January, the other major source of guidance for American doctors treating
people with HIV, the DHHS/National Institutes for Health, will publish their own
revised guidelines. 快猫短视频 has learned these will also adopt the
more cautious approach favoured by British experts.
Anthony Fauci, head of the NIH鈥檚 AIDS research division programme, has
publicly stated that doctors have underestimated how difficult it is to stick to
the treatments.
Anti-HIV drugs have been linked to a disfiguring redistribution of body fat,
liver disease and damage to mitochondria, as well as less specific ailments such
as nausea and tiredness. The drugs also have to be taken in complex combinations
every day.
鈥淚t does reduce the quality of life for several years,鈥� said Carpenter. But
both doctors noted that the drugs have been successful in extending the lives of
people with AIDS.
Nonetheless, Weller added that the start of treatment might have to be
delayed even further, as new side effects emerge. He noted that the vast
majority of serious AIDS-related infections occurred in people with CD4 counts
less than 200.
The speakers agreed that early treatment might be justified in people who had
only just become infected. In such people, there was still the possibility of
protecting a special class of T cells that are destroyed very early in
infection.