final program.qxd - Parallels Plesk Panel

OP 7.1.1
We can now avoid lipodystrophy/metabolic complications in newly treated
patients ? PROS
No abstract available
OP 7.1.2
We can now avoid lipodystrophy/metabolic complications in newly treated patients?
CONS
I Poizot-Martin, Marseille, France
ABSTRACTS
The introduction of highly active antiretroviral therapy regimen since 1996 has
significantly modified the course of HIV disease with longer survival rates but also longer
exposure to antiretroviral molecules and to HIV itself. Given the current need for lifelong
therapy, considerations of long-term toxicities such as hyperlipidemia and lipodystrophy
are becoming increasingly important when choosing between different regimens.
Important metabolic and cardiovascular differences exist between individual drugs within
the same antiretroviral class and some of them seem to have a more favorable pattern of
adverse effects. However, interactions between these drugs when there are associated in
real life may appeared in the future. Thus, a long term follow up is still necessary to
confirm the results of in vitro studies and those observed in clinical trials. Furthermore,
about 30% of naive patients switch their therapy during the first year after initiation, and
not always for a safe one.
Several epidemiological studies have shown the association between antiretroviral
therapy and cardiovascular risk. The increased risk of MI could not be only attributed to
the lipid abnormalities associated with PI treatment. Indeed, this class has also been
associated with endothelial dysfunction with differences between the different drugs within
the class of PI. However, clinical significance for this toxicity has to be confirmed.
Moreover, PIs also alter nuclear lamin A/C maturation and stability, which can also affect
the cardiovascular system with a premature atherosclerosis. These laminopathies might
also provoke an accelerated aging. Then HIV1 itself and gp120 may induce apoptosis of
endothelial cells independently of PIs. Recently, several pharmacogenetic studies
examined the relationships between genetic polymorphisms and changes in lipids and fat
distribution. Although the results of these studies are not yet helpful for practical treatment
strategies, they highlight the differences in individual susceptibility to drug effects. For all
these reasons, avoiding lipodystrophy/metabolic complications in newly treated patients
remains uncertain.
OP 7.2.1
Triple nRTI Combinations are Obsolete. PROS
No abstract available
OP 7.2.2
Triple nRTI Combinations are Obsolete. CONS
No abstract available
“ Focusing FIRST on PEOPLE “ 59 w w w . i s h e i d . c o m