Brown University News Bureau

The Brown University News Bureau

1998-1999 index

Distributed July 20, 1998
Contact: Carol Morton

Story ideas and expert sources for HIV and AIDS issues

New guidelines stress early potent drug cocktails, individualized therapy

Early, potent combination antiretroviral therapies continue to offer the best hope for preventing AIDS in people infected with HIV, according to updated recommendations from the International AIDS Society-USA. Two years ago, the panel of independent physicians and scientists published the first major peer-reviewed guidelines advocating combination drug therapy. Based on information and drugs available in mid-1998, the update notes that 11 agents in various combinations now provide more choices for initial therapy of individuals with better long-term outcomes. Despite concern for the emerging side effects of long-term treatment, therapies should be continued to fight HIV effectively, the panel recommends in its report. The drug cocktail therapies are responsible for up to a 75 percent decline in HIV-related sickness and death where they are available, says the report's lead author, Charles Carpenter M.D., a professor at the Brown University School of Medicine based at the Miriam Hospital in Providence, R.I. On July 1, the report was published in the Journal of the American Medical Association and presented at the 12th World AIDS Conference in Geneva, Switzerland.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contacts: Charles Carpenter M.D., (401) 793-4025, [email protected]
Donna Jacobsen, International AIDS Society-USA, (415) 561-6720
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Powerful AIDS drugs may promote heart disease

Drug cocktails may prevent early deaths from the HIV virus, but they also may contribute to a longer-term risk of heart disease, according to research presented recently at the 12th World AIDS Conference in Geneva, Switzerland. Brown University researchers have confirmed two independent cardiovascular disease risk factors in some women: disfiguring extra fat around the torso and potentially harmful serum lipid levels. The drugs seemed to impact two of four measured lipid levels, increasing only the cholesterol and low-density lipoproteins (LDL), says lead author Krista Dong, M.D., a medical resident at Strong Memorial Hospital in Rochester, N.Y., who completed this study while in medical school at Brown. In eight women, high triglycerides and a deficit of protective high-density lipoproteins (HDL) - both thought to be additional drug side effects - were found to be pre-existing conditions. This study did not identify the culprit, but all the women had taken cocktails containing protease inhibitors. The study also documented another side effect in some female patients: prominent pregnant-looking bellies, enlarged breasts and in some cases "buffalo hump" fat pads on the back, while fat wasted from their arms, legs and buttocks. The researchers hope that two new drugs, which may be available this fall, will prove equally effective in controlling the AIDS virus but without the undesirable side effects on fat metabolism.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contacts: Krista Dong, (716) 453-9991, [email protected]
Charles Carpenter, (401) 793-4025, [email protected]
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Promising results for woman-controlled anti-HIV product

Don't say goodbye to condoms yet, but in the worldwide race to help women protect themselves against AIDS, early studies of vaginal microbicides offer some hope for a new kind of protection against HIV transmission in the genital track. One of the early products in the drug development pipeline, called BufferGel, just cleared its first hurdle, according to Phase I study results reported by Kenneth Mayer, M.D., Jeffrey Peipert, M.D., and Susan Cu Uvin, M.D., at the 12th World AIDS Conference in Geneva, Switzerland. Made by Reprotect LLC, the gel was non-toxic and well-tolerated by 27 women who used it daily or twice daily for two weeks. Side effects were reported by 18 women (primarily mild vaginal redness or itching) but not serious enough to discontinue use. The mainstay of safe sex has been the male condom - an effective barrier to semen that may contain infectious HIV - whose success depends upon a cooperative male partner. There is strong interest in such woman-controlled anti-HIV products, according to a related study involving women at high risk of HIV infection through their own or their partner's drug use.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contact: Kenneth Mayer, (401) 729-2776, [email protected]
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Answers to access, adherence and tolerance of protease inhibitors

Protease inhibitors - the backbone ingredient of the potent triple therapy drug regimen - may not be performing as well in practice as they did in clinical trials, and some patients who could benefit from them may not be receiving them, according to three studies presented recently at the 12th World AIDS Conference in Geneva, Switzerland. The researchers looked at access, adherence and tolerance of the potent drugs in 254 patients being treated at five urban sites in Boston and Rhode Island. In one study, about 40 percent of 151 patients who tried one or more of the four available protease inhibitors eventually discontinued the drug. The most common reason patients gave was gastrointestinal and systemic side effects, followed by treatment failure, says lead author Valerie Stone, M.D., director of the Hope Center for HIV Care at Memorial Hospital in Pawtucket, R.I., and an assistant professor of medicine at Brown University. The take-home lesson is to optimize treatment regimens for individual patients and to closely manage side effects and toxicity, Stone says. Although they can stick to treatment, women, minorities and patients with less education are less likely to be offered potent drug cocktails containing protease inhibitors, according to the researchers. "While combination regimens containing protease inhibitors can dramatically improve outcomes, not all patients who can benefit are receiving them even when clearly indicated," Stone says.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contact: Valerie Stone M.D., (401) 729-2395, [email protected]
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Better access to clean needles may reduce spread of HIV infection

Recent legislation relaxing Rhode Island's strict syringe laws could help prevent the spread of HIV infection, says Josiah Rich, M.D., assistant professor of medicine at Brown University, based at the Miriam Hospital. The act passed by the Rhode Island General Assembly reduces the penalty for possession of a syringe from a felony to a misdemeanor. Intended to curb illegal drug use, Rhode Island's strict syringe possession laws have been inadvertently boosting HIV infection rates. "The single most effective way to prevent the spread of HIV in Rhode Island is to provide legal access to sterile syringes," says Rich, who serves on the advisory board of the state health department's needle exchange program. "It's a proven public health strategy." Intravenous drug users share and reuse needles an average of 24 times in Rhode Island, according to a study by Rich and his colleagues of 477 people in a pilot needle exchange program. The study was published in a syringe supplement to this month's Journal of Acquired Immunodeficiency Syndromes and Human Retrovirology. Rich has been advocating new laws to reduce the penalties for syringe possession as part of a comprehensive strategy that includes drug treatment and programs discouraging drug use.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contact: Josiah Rich, M.D., (401) 793-4770, [email protected]
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Doctors scale prison walls to help women at risk for AIDS stay out of jail

Having a regular doctor and continuous medical care from inside prison to the outside reduces risky behavior for spreading HIV and keeps women out of jail, according to Brown University studies presented earlier this month at the 12th World AIDS Conference in Geneva, Switzerland. With more than one-third of Rhode Island's HIV-infected women first diagnosed behind bars, the prison system has become a key place to prevent HIV infection and to treat women at risk for AIDS. Women who saw the same doctor for at least two years were more likely to stay out of jail than those who did not have a regular doctor, according to a study of 1,148 women infected with HIV or at high risk for HIV infection in Providence, Baltimore, New York and Detroit, even when counting drug use and prior prison time, according to a study by infectious disease specialist Tim Flanigan, M.D., and his colleagues at Brown University and Miriam Hospital. Short-term recidivism rates dropped by half for women who received continuous medical care from inside jail walls to outside, says Flanigan, who directs one of the first programs in the country to provide HIV-infected inmates with continuous health care during and after incarceration. In the Rhode Island studies, the 48 women with HIV and 73 women at high risk for HIV also received counseling and referrals for substance abuse, financial resources, social support and housing.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contact: Tim Flanigan, M.D., (401) 793-7152 or 785-5056 (beeper)
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Worrisome delay between positive HIV test and medical care

Although early treatment can mean longer and healthier lives, many people who test positive for HIV wait a year before seeking medical care, according to a paper in the April 12 Archives of Internal Medicine. Researchers assessed 189 outpatients at Boston Medical Center and Rhode Island Hospital who were seeking care for the first time. Thirty-nine percent had waited more than one year after their original diagnosis before seeking medical care. About one-third (32 percent) waited more than two years, and nearly one-fifth (18 percent) delayed more than five years after their original diagnosis. Early medical intervention helps the patient through increasingly aggressive early treatment and boosts public health by educating patients to help decrease further spread of the virus, say lead author Jeffrey Samet, M.D., associate professor of medicine and public health at Boston University School of Medicine, co-author Michael Stein, M.D., Brown University associate professor of medicine, and their colleagues. People most likely to delay medical care were those having a history of injection drug use or alcohol abuse, not having a living mother, not having a spouse or partner, not being aware of HIV risk before testing, and being notified of HIV status by mail or telephone.

News Bureau: Carol Cruzan Morton, (401) 863-2476, [email protected]
Media contact: Gina DiGravio,Boston University, (617) 638-8491