WELLNESS STARTS WITH AWARENESS - CD8 T cells - The Body

The Buzz continued
and tipranavir were allowed to be added, there were more declines
in viral load.
At the time of this writing, the current issue of the New England
Journal of Medicine (July 24, 2008) reported the fi ndings of
treatment with raltegravir (RLV) in a combined analysis of both
Benchmark studies, which looked at treatment-experienced
patients. Also common to the Gilead study, only patients who were
resistant to three classes of HIV drugs were included. Overall the
results showed a caliber of viral suppression being among the best
ever seen for patients with triple-class resistance. At week 16, the
combined analysis of both studies showed 72% of patients on raltegravir
achieved viral loads below 400 copies, compared with 37%
in the control group. Also at week 48, 62% of patients treated with
RLV achieved a level of HIV-RNA to below 50 copies, compared
with 33% in the placebo arm. It’s worth noting that when patients
were also treated with either darunavir (Prezista) or enfurvitide
(Fuzeon), or both, the rates of HIV suppression were even greater.
Although the rates of side eff ects and adverse events were
low during the 48 weeks of RLV treatment, part of the journal’s
article was devoted to the issue of new malignancies and cancers
seen in the raltegravir group. Cancer in this study was seen early
during the trial (average time of diagnosis was at 68 days) and was
observed at a rate of 3.5% in the RLV treated patients versus 1.7% in
the control arm. It is well worth noting that cancers are increasing
among patients with HIV disease and are of a diff erent type than
was seen prior to HAART. Also, new malignancies have now been
seen in other studies, as well. Historically, we witnessed Kaposi’s
GS 9350 has the potential of
permanently replacing Norvir
as a booster, especially if it
is priced properly, which one
would expect.
sarcoma (KS) and non-Hodgkins Lymphoma to be the most common
of cancers in this population. Presently, anal cancer, liver
cancer, and Hodgkin’s lymphoma are becoming increasingly more
common. Th is is probably due in part to patients having damaged
immune systems and individuals who have had detectable virus in
the blood (persistent viremia). Th us, it is the opinion of this author,
50
that treatment of HIV disease be initiated earlier and that detectable
viral loads be treated with a more eff ective regimen at the onset
of failure. In other words, not to let continued failing regimens be
left untreated, regardless of CD4 T-cell count.
Additionally, the theory of immune system activation (immune
reconstitution syndrome) seen commonly when starting or initiating
a new regimen has also been invoked as a possible cause of
detection of cancer. Herpes zoster (shingles) is one of the most common
manifestations of immune reconstitution syndrome. As the
immune system goes into overdrive, sometimes unexpected events
can happen, that is, new infections, as well as cancers, can occur
during this period of new treatment. Physicians should be increasingly
on the lookout for new problems when patients’ immune systems
are challenged with new therapy.
Norvir may become erased!
A new one pill, once-daily cocktail
Raltegravir is currently dosed at 400 mg twice daily, while elivitegravir
is dosed once daily but at 150 mg plus 100 mg of ritonavir
as its booster. Gilead Sciences has oft en been shown to be a leader
in development of HIV treatment (i.e., Vistide, Viread, Truvada,
and Atripla, all keystone accomplishments); most were surprised
with the recent announcement of their development of a new compound
that can serve as a booster (like Norvir) to EVG, and to other
protease inhibitors. Th e compound known presently as GS 9350
is purely a pharmacokinetic enhancer and
does not have antiviral eff ects. As such, it
is not expected to cause the metabolic side
eff ects that have been associated with Norvir.
GS 9350 has the potential of permanent-
ly replacing Norvir as a booster, especially
if it is priced properly, which one would
expect.
Th is begs me to refer to the movie
“Eraser” with Arnold Schwarzenegger.
Among Arnold’s one liners are “You’ve just
been erased,” or referring to being erased,
“Next time you’re dead… this only happens
once.” One of these greetings may eventually
be handed to Norvir, if development of
GS 9350 goes according to plan. Anyhow, Gilead will eventually
combine their enhancer or booster with EVG to be formulated into
a one dosing tablet. Also, look on the horizon for EVG combined
with GS 9350 plus Truvada, as a new one pill once-daily treatment
cocktail currently being called QUAD, again, if the future studies
continue to go smoothly.
PA • September / October 2008 • tpan.com • positivelyaware.com
Positively Aware