An independent panel of experts convened by the NationalInstitute of Allergy and Infectious Diseases has releasedpreliminary recommendations on the treatment of HIV-infected people with anti-retroviral drugs.
In light of the many uncertainties in the data, the panel of 18experts, led by Merle Sande, chief of medical services at SanFrancisco General Hospital, emphasized the need for physiciansto work with their patients to tailor treatment. The choice toaccept or reject anti-retroviral therapy ultimately rests withthe patient.
And while anti-retroviral therapy early in the infection isoptional, good management of the patient's overall healthstatus is not.
For patients with T cell counts of 500/mm 3 or greater whohave never received anti-retroviral therapy, the panelrecommended observation and clinical and immulogicalmonitoring every six months. Those with T cell counts of 200 to500 who are stable can continue monitoring or begin anti-retroviral therapy. Those within this range who aresymptomatic should begin anti-retroviral therapy.
AZT is still the first-line anti-retroviral therapy. Combinationtherapy may be considered, but studies have not yetdemonstrated clear benefits.
For patients who are intolerant of AZT or whose diseaseprogresses despite it, the panel recommended switching to ddImonotherapy if the T cell count is below 500. For AZT-intolerant patients whose T cell count drops below 50, thepanel recommended ddI or ddC monotherapy.
Final recommendations will be submitted to a peer-reviewedjournal in July. The recommendations are based on 14published studies, including the AIDS Clinical Trials Group andthe Concorde Study. -- David C. Holzman
(c) 1997 American Health Consultants. All rights reserved.