Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Accessible Antiretroviral Drugs
- Matiram Pun (25 March 2005)
-
HAART- what is the best way?
- DR. ANIRBAN DEB (27 March 2005)
-
Re: HAART- what is the best way?
- Nicholas Bennett (30 March 2005)
|
|
|||
|
Matiram Pun, Medical Student Kathmandu, Nepa
Send response to journal:
|
Dear Editor, The antiretroviral drugs have raised a ray of hope among the millions of HIV positives around the world, who were otherwise awaiting impending deaths and social stigma. The different regimens, non compliance and side effects to the efficacy of the drugs are there (1) but how about the accessibility to the drugs that have been available now for others who are in the dark corners of the world. The challenge is the distribution of the drugs to the worst hit parts of the world eg Sub Saharan Africa, South East Asia and some parts of Latin America. Of course, the newer and effective regimens are to be studied and forwarded but that will be meaningless if the source of infection goes on glowing from the different corners of the world that can neither buy the drugs nor taken into attention by us. Matiram Pun Institute of Medicine Kathmandu, Nepal Reference: 1.Murri R. Highly active antiretroviral therapy.BMJ 2005; 330: 681-682 [Full text] Competing interests: None declared |
|||
|
|
|||
|
DR. ANIRBAN DEB, CONSULTANT PULMONOLOGIST Seven Hills Hospital, Visakhapatnam-530002, INDIA
Send response to journal:
|
Dear Editor, While accessibility of antiretroviral drugs has improved to some extent in the recent past, confusion remains regarding the best way of treating the patient. The guidelines (GUIDELINES DEVELOPED FOR THE USE OF ANTIRETROVIRAL AGENTS IN HIV-1-INFECTED ADULTS & ADOLESCENTS,October 29, 2004,Developed by the Panel on Clinical Practices for treatment of HIV infection ,convened by the DEPARTMENT OF HEALTH & HUMAN SERVICES)recommend maximal and durable suppression of viral load for the majority of individuals infected with HIV.Major limitations in achieving this goal are inadequate adherence, drug toxicities & complex drug interactions. Though the controversy regarding initiating ART has been taken care of by the guidelines to some extent, the same cannot be said regarding continuation & interruption/stopping of treatment.The guidelines have only arbitrary suggestions regarding CD4 threshold for interrupting & reinitiating ART (antiretroviral treatment). In this regard the SMART study (Official Title: A Large, Simple Trial Comparing Two Strategies for Management of Anti-Retroviral Therapy ) is certainly going to be closely watched as the outcome unfolds over more than 10 years; the two approaches, viz.,Drug Conservation & Viral Suppression which are to be compared in this trial have their own potential merits & demerits. The limitations of the latter strategy are already well documented.However, as mentioned in the guidelines, no definitive data exist on stopping ART & no prospective clinical trial has been conducted to assess the long term safety of this strategy. Hence this trial may provide answers to many such controversies which will be valuable in countries like India with colossal load of AIDS & TB, where optimum utilization of the currently available drugs remains of paramount importance (till the availability of more potent, safe & economical antiretroviral drugs) to achieve control over this epidemic. Competing interests: None declared |
|||
|
|
|||
|
Nicholas Bennett, Infectious Disease Postdoc/Clinician Department of Pediatrics, University Hospital, Syracuse NY
Send response to journal:
|
I think this also highlights the fact that 20 years on, we still have no cure and no vaccine. Hopes have been raised and dashed in these areas several times, and it seems as if there is always "something on the horizon". We're running out of viral enzymes to target, and I see no reason why more of the same will result in a dramatic paradigm shift with regards to treatment of HIV/AIDS. HIV infection is a complex disease, with important effects due to non -viral factors such as psychiatric and nutritional health (although arguably the virus itself and secondary infections may contribute to even these, especially with regard to GI illness). HAART is a broad antiviral approach in that it hits multiple viral enzymes, but is still perhaps narrow in that it only considers the direct effects of one virus. Maybe, as others [1] have strongly argued elsewhere, it is time for an even more comprehensive approach to managing HIV infection, until such times as a definitive vaccine or eradication therapy arises. Such things as nutritional replacement and/or supplementation require formal testing and proving to get mainstream acceptance, but from the little I've read in and around the topic I think it's well worthwhile. It too won't provide a cure, nor will it be an excuse to cease methods to prevent transmission, but it may buy more time and a higher quality of life for those struggling with the current standard of care. Nick Bennett njb35@cantab.net 1. Many articles by James Whitehead on the Rapid Responses http://bmj.bmjjournals.com/cgi/eletters/326/7387/495 Competing interests: None declared |
|||