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Pearls of Wisdom from the 12th CROI -
Boston, MA – February 2005
This year’s Conference on Retroviruses and Opportunistic Infections was especially packed with information on the treatment of both HIV and Hepatitis infections. I would like to provide you with a brief but important summary just as the conference wraps up.
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The amount of information presented on the treatment of opportunistic infections, the infections that used to kill people (such as pneumocystis pneumonia, kaposi’s sarcoma, CMV retinitis, and cryptococcal meningitis) is very small these days. For this we can thank the era of HAART or highly active antiretroviral drug therapy. However, about a third of the conference is now dedicated to studying the serious complications and side effects caused by these drugs.
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The use of what are known as thymidine analogue drugs (including D4T and AZT) is now clearly implicated in the development of fat loss from the face and limbs. Drug combinations that do not include these drugs are now being studied to help decrease the incidence of this disfiguring side effect. Drugs such as Ziagen (abacavir) and Viread (tenofovir) are not believed to cause these effects to any significant extent.
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The longer a person takes HAART medication, the greater the incidence of cardiovascular incidents such as heart attacks. The most significant thing a person can do to lessen this risk is to stop smoking as well as improve cholesterol levels (with or without the use of statin medications). Delaying the need to go on HAART therapy and taking treatment interruptions whenever possible could also help.
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There has recently been a discovery of a strain of HIV able to destroy a person’s immune system in a manner of months (instead of years) and which is immune to most of the currently available antiviral drugs. The patient with this strain turned up in NYC about three weeks ago. This is extremely concerning. It is important to mention that this highly aggressive strain of HIV developed in the body of an individual who was regularly using crystal methamphetamine and having sex with multiple anonymous partners. If this strain is “more fit” than the current wild strain of HIV, it is possible that someone who is already HIV(+), and having unprotected sex with other HIV(+) individuals, could become re-infected with a more potent strain of HIV that is resistant to some or all of the drugs they may currently be taking. The take home messages are clear: 1) If you are HIV(+) and having unprotected sex with other HIV(+) individuals, you are at risk for re-infection with a strain that is different than your own 2) Don’t do crystal methamphetamine! It is extremely addictive and harmful to your immune system and can negatively affect your life in a big way.
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Finally, a very well respected researcher presented the following information: The vast majority of CD4 cells reside in the mucosal lining of the gut, not in the blood or lymph nodes. This is a fact. The more these immune cells are activated and stimulated, not only by HIV but by other gut pathogens such as intestinal parasites and candida as well, the more quickly these CD4 cells will die. Therefore, I will reiterate something that I have said for ten years. There is no such thing as a good parasite! Everyone who is HIV(+) should get tested for parasites once a year and any parasites that are found should be treated. You need to get your gut “squeaky clean” to stand the best chance of living a normal, healthy lifespan with HIV. Your gut stays healthy by eating a diet low in sugar and junk, supplementing it with acidophilus and other healthy GI supplements (enzymes. L-glutamine, etc.) and avoiding the high risk sexual behaviors that put you at greater risk for exposure to parasites (you know what I mean!).
On that note, I leave Boston (very cold!) to return back to San Francisco (very wet!). I hope that you are keeping warm and dry wherever you are! We continue to make great strides in the treatment of HIV and living a healthy, normal lifespan MUST continue to be the goal.
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