Πέμπτη, 11 Απριλίου 2013

20th Conference on Retroviruses and Opportunistic Infections, Atlanta, USA CROI 2013 – Nέα από το συνέδριο για τους Ρετροϊούς και τις Ευκαιριακές Λοιμώξεις, ΗΠΑ –ΜΑΡΤΙΟΣ 2013

Research involving treatment – experienced patients has shown that it is possible to construct effective antiretroviral regimens that do not include drugs from the nucleoside reverse transcriptase inhibitor (NRTI) class.
Improvements in treatment mean thah an undetectable viral load is a realistic goal for nearly everyone including people who have changed treatment several times (sometimes referred to as having extensive experience of HIV treatment) and who have drug – resistant virus.

Combinations for heavily treatment – experienced patients are selected after testing for drug resistance. 

They often include drugs the patient has taken previously (“recycled” drugs), including NRTI agents that after only partly effective.

But this strategy increases the number of pills a person has to take ( the “pill burden”) and can also lead to more side – effects.

Doctors in the US wanted to see if it was possible to construct an effective HIV treatment regimen that didn’t include NRTIs.

They therefore designed a study involving 360 people who needed to change their HIV treatment because it was failing. 
All were taking HIV therapy based on a protease inhibitor and had a viral load above 1000 copies/ml.

About half had CCR5-tropic virus and were therefore candidates for therapy with maraviroc (Celsentri, Selzentrv).

έρευνα σε πολυθεραπευμένους ασθενείς απέδειξε ότι είναι δυνατός ο σχηματισμός θεραπευτικού σχήματος χωρίς συμμετοχή της θεραπευτικής κατηγορίας των NRTIS.

Bελτίωση στη θεραπεία σημαίνει οτι η επίτευξη αρνητικού HIV φορτίου είναι ρεαλιστικός στόχος για όλους, συμπεριλαμβανομένων των ασθενών που έχουν αλλάξει πολλές φορές τη θεραπεία τους και άρα έχουν έναν ανθεκτικό ιό.

Οι θεραπευτικές επιλογές για αυτούς τους ασθενείς απαιτούν την ύπαρξη ελέγχου έναντι της αντοχής του ιού στα φάρμακα.
Πολλές φορές συμπεριλαμβάνουν φάρμακα που έχουν ήση χρησιμοποιηθεί και ανήκουν στην κατηγορία των NRTIs που είναι μερικά μόνον αποτελεσματικά.
Αυτή η στρατηγική αυξάνει τον αριθμό χαπιών που καλείται να καταπιεί ο ασθενής και βέβαια μπορεί να οδηγήσει σε παρενέργειες.

Ετσι σχεδιάστηκε στις ΗΠΑ, μια μελέτη σε 360 ασθενείς  που ώφειλαν να αλλάξουν τη θεραπεία τους.

Ολοι έπαιρναν αναστολείς πρωτεάσης και είχαν φορτί > 1000 cp/ml.

Το 50% είχε έναν ιό με τροπισμό για CCR5 υποδοχέα και επομένως ήταν υποψήφιοι για θεραπεία με maraviroc (απαιτείται για  τη λήψη του φαρμάκου, η ύπαρξη αυτού του υποδοχέα).

The most widely used combination comprised the integrase inhibitor raltegravir (Isentress), the ritonavir – boosted protease inhibitor darunavir (Prezista) and tha NNRTI etravirine (Intelence).

Doctors and study participants then selected the NRTIs they’d most like to use.

The participants were randomized to take or omit these NRTIs from theirdrug regimen.

After one year, treatment outcomes were broadly similar between the people who took NRTIs and those who omitted this class of drug. Similar proportions had detectable viral load (26 vs 30%) and CD4 cell gains were similar.

Omitting NRTIs didn’t seem to have any benefits in terms of side – effects.

One of the study investigators concluded, “You don’t need to include NRTIs when new active agents are on board”.

Ο πιό συχνά χρησιμοποιούμενος συνδυασμός φαρμάκων περιελάμβανε τον αναστολέα ιντεγκράσης (isentress)  αναστολέα πρωτεάσης (prezista) και το NNRTI  intelence

Μετά οι γιατροί και οι ασθενείς επέλεξαν το NRTI που θάθελαν να συμπεριλάβουν στη θεραπεία τους. 

Οι συμμετέχοντες τυχαιοποιήθηκαν να λάβουν ή να παραλείψουν το NRTI στη θεραπεία τους. 

Μετά ένα χρόνο, τα θεραπευτικά αποτελέσματα μεταξύ των δύο ομάδων ήταν πρακτικά παρόμοια. 
Ενας από τους ερευνητές συμπέρανε: δεν χρειάζεται να συμπεριλάβεις NRTIs στην θεραπεία πολυανθεκτικών ασθενών όταν υπάρχουν νέα δραστικά φάρμακα

New anti – HIV drug dolutegravir

The new integrase inhibitor dolutegravir appears to outperform raltegravir (Isentress) in treatment – experienced patients with resistance to two or more anti – HIV drugs.
Dolutegravir has performed well in clinical trials and is currently awaiting regulatory approval in Europe, Canada and the US.
The present study involved 715 people with detectable viral load despite taking HIV therapy.
All had resistance to two or more anti – HIV drugs. 
However, none had previously received therapy with an intergrase inhibitor.
They were randomized to take either dolutegravir or raltegravir as part of their HIV treatment combination.
Six months later, 79% of the study participants who were taking dolutegravir has an undetectable viral load compared to 70% of those talking raltegravir.
Outcomes were especially favourable for dolutegravir among people who had a high viral load at the start of the study.
Treatment was stopped by 2% of participants in the dolutegravir group compared to 4% of people taking raltegravir.

Kan. agency's promise ends dispute on AIDS measure

σχόλιο δικό μας: 
Η συζήτηση για Υγειονομικές διατάξεις και νομοθετήματα για Καραντίνα δεν είναι Ελληνική Πατέντα, είναι μιά "Γενικότερη Διάθεση". 
Στις ΗΠΑ όμως οι Γιατροί ήταν κάθετα αντίθετοι στο ότι ο Hiv/aids δεν αποτελεί πρόβλημα για να τεθεί μιά περιοχή σε καραντίνα ούτε αιτία για ποινική δίωξη στους Οροθετικούς λέγοντας τα παρακάτω...  
ακολουθεί το άρθρο που δημοσιέυτηκε στις 4 Απριλίου
-Η ΕΕΜΑΑ (Ελληνική Εταιρία Μελέτης & Aντιμετώπισης του Aids) που έχει εκπροσώπους της στο Δ.Σ. του ΚΕΕΛΠΝΟ αναφορικά με την Υ.Δ. 39Δ /Απρ 2012, έχει τηρήσει...-
By JOHN HANNA, AP Political Writer Updated 6:57 pm, Thursday, April 4, 2013 

Kansas state Sens. Mike Petersen, left, of Wichita; Les Donovan, center, also of Wichita, and Garrett Love, right, of Montezuma, confer during a break in the Senate' work, Thursday, April 4, 2013, at the Statehouse in Topeka, Kan. The three senators are all Republicans.  
Photo: John Hanna

TOPEKA, Kan. (AP) — A promise from Kansas' health department Thursday to continue protecting AIDS and HIV patients from being quarantined has resolved a dispute over a legislative proposal for helping medical personnel and emergency workers who may have been exposed to infectious diseases.

State House and Senate negotiators agreed on the final version of a bill that still would repeal a 25-year-old law specifically banning state and local health officials from quarantining people with AIDS or the virus causing it.
Both chambers voted to rescind the law, but the move faced strong criticism, including from the Kansas Equality Coalition, the state's leading gay rights group.

Kansas Department of Health and Environment officials said that even without a specific ban, state law prevents quarantines unless they are reasonable and medically necessary — conditions that cannot be met for AIDS and HIV patients.
The final version of the bill repeats those limits on quarantines, but critics had said such language wasn't enough to protect AIDS and HIV patients from potential discrimination.

Other provisions of the bill require KDHE to draft rules by the end of the year to ensure that medical personnel and emergency workers learn quickly whether they've been exposed to infectious diseases in treating patients or handling materials.
State Epidemiologist Charlie Hunt pledged to legislators that the rules will spell out which diseases can lead to quarantines, and AIDS and HIV won't make the list.

The promise was enough for the Equality Coalition to accept the bill, though it would prefer to keep the ban on quarantining AIDS and HIV patients in state law.
Legislators hoped to vote on the final version of the measure Friday, when approval in both chambers would send it to Gov. Sam Brownback.
"We're good," said Tom Witt, the Equality Coalition's executive director and lobbyist. "This alleviates our concerns."
KDHE officials and some legislators involved in the negotiations over the bill have been frustrated by the criticism of the measure.

The bill is designed to protect medical personnel, laboratory workers, firefighters, law enforcement officers and prison employees.
Backers say a single set of statewide rules — instead of a hodgepodge of local policies — will make it easier for such personnel to learn whether they've been exposed to diseases and to get tested.

"The whole thing all along has been one big misunderstanding," said lead House negotiator David Crum, an Augusta Republican.

HIV is spread most often through sexual contact, contaminated needles or syringes, infected blood or blood products or from infected women to their babies at birth or through breastfeeding.
Hunt said in a statement the health department never intended to seek authority to quarantine AIDS or HIV because it would never be medically necessary.

And lead Senate negotiator Mary Pilcher-Cook, a Shawnee Republican, said the 1988 law banning quarantines of AIDS and HIV patients became unnecessary over time.

"It was understandable back in the 1980s, when many people were not educated on how HIV was transmitted, but today that's not the case," she said.

Witt said critics never believed state or local health officials contemplated mass quarantines of AIDS or HIV patients but simply wanted to lessen the potential for discrimination against them.

"Our concern is always about people in more remote areas of the state engaging in individual harassment," Witt said.

Meanwhile, the American Civil Liberties Union of Kansas and Western Missouri still has concerns, and lobbyist Holly Weatherford said the group will address them when the state health department writes the rules.
Weatherford said her group worries that the bill would allow state and local health officials to force people who come in contact with medical personnel or emergency workers to be tested in a broad set of circumstances.
The bill is Sub for HB 2183.