Clinicians Find Advances ‘Mind-Boggling’
By Annette M. Boyle
ATLANTA – Therapeutic options for patients with human immunodeficiency virus (HIV) continue to expand, enabling more veterans to begin treatment with fewer adverse side effects and far less complicated regimens than even a few years ago.
“Now that we have multiple documented treatments that work and are well tolerated, we have better options for patients with underlying problems such as heart or kidney disease and those who have developed resistance to the drugs they are on,” said David Rimland, chief of infectious diseases at the Atlanta VAMC.
With HIV, unlike many other conditions, dissemination of information on new treatments is extremely rapid. “One of the interesting things about working with HIV compared to a lot of other diseases is that, as soon as significant results are presented, clinicians latch on to them very quickly, often even before official recommendations or guidelines come out,” Rimland noted.
That’s good news for the more than 24,000 HIV-infected veterans who receive healthcare through the VA. Recent studies may bring even better tidings to veterans who have been unable to take or tolerate the most common combinations of HIV medications.
In October, researchers led by Jeffrey Lennox, MD, professor of medicine at Emory University and Grady Memorial Hospital, both in Atlanta, published results of the first head-to-head study of three non-efavirenz therapies in the Annals of Internal Medicine. That study showed that all three achieved equivalent and high rates of virologic suppression, though there were some differences in their tolerability levels. 1
“We are very pleased that our study showed the drug combinations tested, without efavirenz, are good options for initial HIV antiretroviral therapy. This is critical information for patients who cannot tolerate efavirenz, and we believe this head-to-head comparison will provide useful information to guide clinicians about choosing among them,” Lennox said.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.