Various substances can be used to combat the effects of facial lipoatrophy. In the UK some NHS clinics provide New-Fill (polylactic acid). A private clinic is offering Bio-Alcamid (polyalkylamide). However no one has done experiments to see which works best. Now a plastic surgeon, Dr G Lemperle, has daringly injected himself in the arm with various ‘filler’ products, so he could see how long-lasting these substances were and whether they caused irritation. Top of the list was a substance similar to Bio-alcamid called Aquamid, which lasted over 12 months without dispersing and caused little immune reaction. New-Fill itself had disappeared within four months.
A recent study compared the death rates of patients in seven trials of protease inhibitor (PI)-containing regimes, against seven trials of non-nucleoside (NNRTI)-based ones. The trials compared these triple-drug regimes against the old dual-nucleoside regimes. When the PI and NNRTI trials were compared, there was a big difference. Less than half as many patients on PI triple combos died than patients on dual nukes. But only 10 per cent fewer patients on NNRTIs died than ones taking dual nukes. The explanation is that patients with pre-existing resistance to nucleoside drugs are more likely to benefit from PIs since HIV becomes resistant to them more slowly.
With injectable fusion inhibitor development halted (see story on right), one intriguing idea is to get the body to make its own equivalent of T-20. Scientists have made an artificial gene called C36. When introduced into cells via an infection with a harmless retrovirus it causes the cell to make its own version of a molecule like T-20 that stops HIV getting into the cell. The retrovirus-plus-gene package has passed animal safety studies and plans for human tests are afoot.
Protests continue to mount in the US over the price increase of the HIV drug Norvir® (ritonavir) made by Abbott Laboratories. Thirty-four US HIV clinicians have written a letter to Abbott calling the price increase, from less than $55 a month to more than $250, “outrageous behavior” and urging doctors across the US to boycott Abbott products and events. Meanwhile Lisa Madigan, the Attorney-General of Abbott’s home state, Illinois, said the decision to increase Norvir’s cost might violate the Illinois Consumer Fraud and Deceptive Business Practices Act, and she was launching an investigation. Madigan said: “Norvir is not like a hay fever medication... It is a drug they take to survive.”
A long-lasting injectable contraceptive can raise the HIV viral load in chronic infection, if it is taken by women in the first six months of infection. The link between viral load and the contraceptive was noted in a survey of 161 Kenyan sex workers. It was found women who took the contraceptive medroxy-progesterone acetate had an average viral load in chronic infection of 62,000 as against 29,000 in women who did not. Other contraceptives did not have the same effect.
An unfashionable HIV drug may become popular again. ddC (zalcitabine, Hivid®) was one of the five early nucleoside (NRTI) drugs that were developed before the discovery of other drug classes made combination therapy possible. AZT, ddI, d4T and 3TC remain widely used but ddC languished, for two reasons. Firstly it had to be dosed three times a day and secondly it was strongly associated with the crippling side effect peripheral neuropathy. Now a small study has found that ddC compares in strength to 3TC when dosed twice daily. It also found no instances of peripheral neuropathy among the 24 people who took it. One advantage of ddC is that HIV only becomes resistant to it slowly, and this can often be overcome with a higher dose.
