Delegates to July's 14th International AIDS Conference in Barcelona had barely sobered up when the self-satisfied organizers were promising that the next pow-wow, Bangkok 2004, would be lighter on science and heavier on human rights.
As if these splashy, schmoozy junkets could serve up less science! To quote The Economist on this year's party: "It is hard to imagine being greeted at the door of a conference on particle physics -- or even malaria -- by stilt-wearing actors dressed as Buddhist monks and giraffes." [See "Worlds Collide"].
Even when you set aside Big Pharma's hype of every new product slouching toward FDA approval, you're still left with the often breathless headlines the press manages to squeeze from the big studies. Thus, POZ's attempt to wrest from the media mountain some nuggets of real-world treatment news:
DOCS to PIs: Bye-Bye
For whom did the bell toll at Barcelona? Protease inhibitors. That's how the media spun a slew of studies, among them one led by Rome's Giuseppe Barbaro, MD, reporting 9.8 heart attacks in 750 HIVers on a PI combo vs. 0.8 among 750 PI-free HAARTers. Or consider the Spanish study comparing HIVers starting on a PI-based combo to those starting on a non-nuke-based one -- and finding near-identical outcomes and CD4 counts. But let's not overplay the death of the PI. The more we see first-line non-nuke combos in action, the more we'll see the downsides -- especially resistance (which happens more easily than with PIs). Non-nukes may have won a few battles, but the class war ('twixt drugs, that is) rages on.
Put Your Money on T-20
From The New York Times front page to evening-news bytes worldwide, the media played Roche's ready-for-its-close-up fusion inhibitor Fuzeon (a.k.a. T-20) as the next great treatment hope, trumpeting that it offers an "AIDS lifeline" and "slashes virus to undetectable levels." The true take-home? If you have a skimpy 10 percent chance of getting your HIV under control by recycling old drugs, T-20 ups it to 20 percent. That's nothing to sneeze at for people at the end of their treatment hope, but not worth blowing the shofar for, either -- especially because HIV can develop high resistance to it after two measly mutations.
Viread & Zerit In a Tie
The biotech Gilead's buzz-making "903" study of 600 treatment-naivers pitted Sustiva/3TC/d4T (Zerit) against Sustiva/3TC/tenofovir (a.k.a. Viread, Gilead's newish nucleotide analog) -- and after 48 weeks reported equal percentages of undetectable virus (78 percent) and CD4 increases (up 167 vs. 169). Does that make Viread a dead-ringer for Bristol-Myers Squibb's d4T? Maybe, but the average HIV doc probably won't use Viread in starters until the HHS officially recommends it. And with Gilead lacking BMS-sized clout, when will that be?
Hitting Early, Stopping Safe
It's still okay to stop. An Argentine study of 200 HAART-treated HIVers with CD4 counts stably over 350 found that, a year after half had stopped treatment, the HAART-less saw an average viral load change of no more or less than 1,000 (with no one's rising above 100,000), an average CD4 drop of only 14, and no AIDS-related symptoms. What does it all mean? Maybe that those over-achieving asymptomatics who leapt needlessly onto the triple-drug bandwagon -- thanks to HHS recommendations -- can now feel good about leaping off.
Jaded wonks were caught off-guard when Australian Jon Willis, MD, presented his study of the emotional effects of lipodystrophic body changes in HIVers: Up to three-quarters felt outed as HIVers, sexually unattractive and generally miserable. But Willis made his case even more powerful by pointing out his own stick-limbs, puppet cheeks, buffalo hump and big belly, calling them the "cruel ironies" of living with HIV and HAART. "HIV-infected people with these physical body changes feel weird, grotesque, deformed, unloved and unlovable," he said. "Many have contemplated or attempted suicide."
With those words, the room fell into silence -- speaking volumes for just how cruelly imperfect HIV care remains, even in the most privileged corners of the world.