Volume 9 Number 1/2 January/February 2008
Welcome to the first issue of HTB for 2008. Every new year it is always a little sobering to find that we are still producing HTB – and that this year we are startng volume 9.
HIV in Western countries should be a problem that is largely solved. The January update to the US treatment guidelines (see Antiretrovirals) paints the broadest picture with a Table on page 106. Three-yeart risk of progression to AIDS in the pre-HAART era is shown by columns getting progressively higher as baseline viral load increases and CD4 declines. In the post-HAART era the columns barely leave the ground, apart from patients with CD4 counts <200 cells/mm3 generally the result of late diagnosis. Another sobering point is that in most industrial countries a third of new diagnosis are with a CD4 count <200 cells/mm3.
A French cohort (also covered in our Antiretorviral section) calculates that after six years of HAART, patients with CD4 counts over 500 cells/mm3 have a similar life expectancy to age and sex-matched HIV-negative people in the general population.
Through 2007, we reported on the availability of new drugs raltegravir, darunavir, etravirine, maraviroc which together with tipranavir and/or T-20 should enable most patients with even extensive resistance to suppress viral load to below 50 copies/mL, and consequently achieve long-term durable responses.
But this optimism, even in a Western setting, is tempered by an aging HIV-positive population, with the potential for complications with morbidities that are still likely to be higher than the general population including cardiovascular disease.
We have included two reports from the 15th Retrovirus Conference held in Boston as this issue went to press – and will of course include more coverage in the next two issues.
The leading report links abacavir and ddI to an increased risk of cardiovascular events.
These results were unexpected, and have most significance for patients who have high underlying risk of cardiovascular events. They generated a lot of dicsussion and interest at the meeting, and we therefore have also printed a statement from the research group that explain the findings in more detail.
Howver, this shows the importance of large safety studies that can detect signals or side effects that occur at too low and incidence to have been found in registrational studies.
So for all the optimism of new treatment, and there has never been a better time to be optimistic about HIV treatment for poeple living in countries with good ARV access, the importance of post-marketing safety studies should not be forgotton.