12th World AIDS Conference
  
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LAST UPDATE: Wednesday, 1 July, 1998 09:56 GMT   S U M M A R Y     S E S S I O N S  ...all the news, as it happens
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CLINICAL SCIENCE AND CARE - TRACK B
CLINICAL SCIENCE AND CARE - TRACK B
Summary of Monday, 29 June, 1998

 

Introduction

  • Despite a vast amount of new trial data, we still do not know for sure when to treat.
  • Standard of care is sub-optimal when one considers virological failure, compliance and toxicity problems. Treatment is the best guess according to individual needs. There are still often no 1-2 year data to help beyond the best guess.
  • Since the last World AIDS Conference in Vancouver (1996) the messages about antiviral treatments have become more complex and uncertain.

 

Antiretroviral therapy - New drugs and regimens

  • Abacavir (1592) is a nucleoside inhibitor of the HIV retrotranscriptase.

Results presented showed that a combination of AZT-3TC-abacavir is superior to AZT-3TC.

Abacavir is safe and well tolerated in adults. The drug has a potent effect after 16 weeks of treatment. However, the study is recent and has a short follow-up.

A study in children with prior antiretroviral therapy indicate a diminished response in these patients. The hypersensitivity syndrome associated with abacavir does not seem to be more common in children than in adults.

  • Efavirenz-AZT-3TC is a potential candidate for first line therapy. It is better tolerated and at least as potent as the existing standard of care (AZT-3TC-indinavir).
  • Ritonavir plus saquinavir was found to be better than either ritonavir or indinavir added to one or two nucleoside analogues of the HIV retrotranscriptase in protease-naïve patients.

 

Cytomegalovirus (CMV)

  • Highly active antiretroviral therapy (HAART) suppresses CMV replication.
  • Withdrawal of CMV maintenance therapy can lead to vitritis.

 

Hepatitis C

  • There are conflicting studies reporting about whether HAART is associated with hepatic failure.

 

Nursing

  • Strengthen the continuity of care for the patients into the home setting.
  • Present type of care varies according to the national setting.

 

Care in resource-limited setting

The main issues remain :

  • Facilities such as clean water, hospital beds and health care system infrastructure;
  • Personnel - skills in care;
  • Ethical issues and in particular confidentiality;
  • Discrimination and stigmatisation.

Progress was reported in the following areas :

  • Training in various care aspects such as counselling;
  • Increase access to home care;
  • Improvement in survival of HIV+ persons;
  • Cost-effectiveness;
  • Evolution of care models;
  • Increasing partnership between NGO’s and government;
  • Community acceptance.

The challenges which remain to be tackled :

  • Increasing number of HIV+ people;
  • Treatment of opportunistic infections;
  • Limited access to voluntary testing;
  • Increasing number of AIDS-related deaths.

 

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