NEWS ON THE FIGHT FOR BETTER TREATMENT, A VACCINE, AND A CURE FOR AIDS
Annus Mirabilis: A Look Back at an Extraordinary Year for Basic and Clinical Research on AIDS — and the Questions Raised
From tagline December 1996
by Mark Harrington
The year 1996 witnessed seismic developments in AIDS research. On many fronts -- the basic and the clinical, the biomedical and the behavioral -- the very ground has shifted under our feet. It appears that we may have the opportunity, previously just a distant hope, to preserve health and life for many more people living with HIV than ever before. At the same time, we face difficult, new and sometimes bitter contradictions: effective preventive strategies are stymied by political leaders for political reasons; the direction of AIDS vaccine research remains unclear and its accomplishments scant; new therapeutic approaches are inaccessible to over 90% of the world's people living with HIV; and the future direction of the entire research enterprise is still a matter of contentious debate.
Viral Load in Vancouver
A Report from the 11th International Conference on AIDS
July 1996 - The year 1996 has brought a sea change in AIDS research and treatment. Three major factors have contributed to this sea change: a new understanding of viral pathogenesis, new and powerful antiretroviral treatment regimens, and new, more powerful tools for measuring HIV levels in the blood and elsewhere in the body. Indeed. it was due to the sensitivity of these new viral load assays that researchers were able to determine the kinetics of HIV replication and immune system clearance within the infected human host, and devise new therapeutic approaches to reduce viral replication. This report is an interim attempt to survey the rapidly-evolving field of research using viral load tests for the diagnosis, prognosis and treatment of HIV infection, to determine what is known and to pose some questions about what remains to be determined.
Access Versus Answers
by Mark Harrington
After Berlin, no one could credibly believe that AIDS drug development was on track. Indeed, it looked likely that the various initiatives AIDS activists had worked with FDA, NIH and industry to develop were actually impeding the gathering of useful information about safety and efficacy. The first generation of anti-HIV drugs, the nucleoside analogues – AZT, ddI, ddC, d4T and 3TC – just weren’t very good, but the studies to prove their efficacy were designed over-optimistically. As a result, many studies were too small to show anything useful. The Concorde study questioned the use of early AZT and the use of surrogate markers like short-term CD4+ T cell changes to indicate longer-term clinical benefit. ACTG 155 questioned the prevailing, but never proved, dogma that two anti-HIV drugs might be better than one. It was time to take a critical look at the way drug trials were carried out, and to demand changes to resolve the issues raised by the nucleoside analogue trials.
The Wasting Report: Current Issues in Research and Treatment of HIV-Associated Wasting and Malnutrition
by Tim Horn & David Pieribone
Wasting syndrome can be a chronic and deadly manifestation of HIV. Multiple studies demonstrate that progressive weight loss and wasting are highly predictive of disease progression and death. However, wasting syndrome has been underemphasized, not only in clinical care, but also in basic clinical research. Currently, no standard of care exists for monitoring HIV-infected people for malnutrition, wasting and weight loss, and there is no clear consensus regarding the optimal ways to diagnose and treat these complications of HIV disease.