Combating HIV : treating safely and for the long term

[3 August 2009 - 14h56]
[mis à jour le 24 August 2009 à 17h58]

Combating HIV – treating safely and for the long term

The use of recent drugs has made it possible to obtain good results in around 90% of people infected with HIV. The quality of life and the long-term consequences associated with these treatments are thus taking the lead over other considerations.

At the 5th International AIDS Society (IAS) Conference held in Cape Town, South Africa, a multinational effort involving 83 teams has shown the superiority of using a triple drug combination of reverse transcriptase inhibitors (NRTIs) over a more traditional approach combining antiprotease drugs and NRTIs. With comparable clinical results, this new approach has made it possible to reduce the lipid impact of the treatment and the risks of secondary cardiovascular effects.

Co-ordinated by Professor Vicente Soriano (of the Infectious Diseases Unit at Carlos III Hospital, Madrid), the ARTEN study compared two combination options using Tenofovir/Emtricitabine (Truvada®). In this study, 569 patients received either a combination of d’Atazanavir and Ritonavir – two antiprotease drugs – or Nevirapine (Viramune®). The latter, which has been available for 13 years, is the oldest of the non-nucleoside reverse transcriptase inhibitors. Used worldwide, and already available in generic forms, it has been utilised in many humanitarian and/or compassionate distribution programmes. Nevirapine is a known reference treatment in the prevention of mother-to-child (M-T-C) transmission of HIV.

This study has shown that “in 67% of patients instead of 65% (in the other group), the Truvada®/Viramune® combination renders viral load undetectable at an early stage”. Furthermore, Vicente Soriano explains, its impact on blood lipids is very favourable: “a reduction in LDL cholesterol – the so-called “bad” cholesterol (ed. note) – and an increase in HDL – cholesterol levels at more than twice those obtained using antiprotease drugs.

This is a key factor because lipid problems are a constant concern for HIV sufferers. They lead to deformations and increase cardiovascular disease. As Professor Jean-Michel Molina (Saint-Louis Pasteur Hospital, Paris) points out, it is becoming possible “to select suitable patients (those likely to have better tolerance) and obtain very good effectiveness without serious intolerance …. And this can be achieved without the increasingly serious cardiovascular disadvantages now associated with the antiprotease drugs. It is a study that has revived the fortunes of a molecule that had tended to be neglected.”

That’s right … research too has its “fashions”… “In 1996-97, nobody talked about anything except antitprotease drugs, explained Professor François Raffi (of Nantes University Hospital). “But when we look at the 26 or 28 antiretroviral drugs available today, we are surprised to see the position Nevirapine still occupies after 13 years. Of the 1,300 patients we monitored, around 35% receive the drug daily. Because, in fact, 80% of HIV sufferers will never experience AIDS itself. We will need to go on treating them for 30 or 40 years and it is important to check the treatment for tolerance and durability. We must also do everything we can to avoid the co-morbidity associated with antiretrovirals…”

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; ARTEN study (Atazanavir/Ritonavir on a background of Tenofovir and Emtricitabine (Truvada®) vs Nevirapine); interviews with Professor Vicente Soriano and Professor J-M. Molina, 19 July 2009, and Professor François Raffi, 22 July 2009

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