Monthly Archives: May 2012

HIV cure: How to Monitor the Patient on Antiviral Therapy

Monitoring Antiviral Therapy:

The goals of antiviral therapy are to enhance immunity and delay or prevent clinical advancement to symptomatic disease without inducing important side effects or selecting for drug resistant virus. Currently, the best marker of a drug’s activity is a decrease in the viral load.

Ideally, before initiating treatment, the viral load and the CD4 cell count should be checked and the viral load test then repeated after approximately four weeks of treatment. If the patient is beginning a regimen that includes two to three drugs for which the patient’s virus does not appear to be resistant, it is expected that the amount of virus should decrease by at least hundredfold during this interval i.e., 4 weeks. The ultimate goal is for the viral load to decrease to undetectable levels which should occur by approximately 24 weeks. Those that are not having an appropriate response to therapy need to be questioned to make sure that they are taking their medications correctly, and if not, why. If the viral load is not going to undetectable levels and the patient is taking the medications correctly, then it is likely that there is a resistant virus to some of the medications. Drug-resistance testing then should be performed and the patient should be managed as described in the next section. Continue reading →

Side effects of HIV therapy:

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There are many potential side effects associated with antiviral therapies. The most common ones for each class of drug are summarized below.

NRTIs

Most NRTIs can cause mild nausea and loose stools. In general, these symptoms resolve with time.

ZDV has been associated with decreased production of blood cells by the bone marrow, most often causing anemia, and occasionally hyperpigmentation (most often of the nails).

D4T can damage nerves and cause peripheral neuropathy, a neurological condition with numbness and/or tingling of the feet and hands, and inflammation of the pancreas (pancreatitis) that causes nausea, vomiting, and mid upper abdominal pain.

DDI also causes pancreatitis and, to a lesser extent, peripheral neuropathy. Peripheral neuropathy can become permanent and painful, and pancreatitis can be life-threatening if therapy is not discontinued. The drug ddC also is associated with peripheral neuropathy as well as oral ulcers. Continue reading →

Nausea, vomiting: Causes and Nausea Treatment

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What is nausea?

Nausea is the sensation that the stomach wants to empty itself, i.e., feeling as one is just going to vomit, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

Vomiting is emptying the stomach as a result of strong gagging and retching that leads to throwing up. The stomach’s contents are forcefully expelled through the mouth. Vomiting can come in waves as the natural movement (muscle contractions of the digestive system known as peristalses) is reversed, and involuntary contractions in the walls of the stomach and esophagus force the stomach contents out. Sometimes coughing or spitting up mucus from the lungs is confused with vomiting. Vomiting can only come from the stomach.

Retching is the reverse movement (peristalsis) of the stomach and esophagus without vomiting. Sometimes this is called the dry heaves. Continue reading →

HIV Treatment Drugs

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Initial therapy for HIV

Guidelines for using antiviral therapy have been developed and are updated on a regular basis by an expert panel assembled by the DHHS, the IAS-USA panel, and others. The DHHS guidelines are available at http://www.aidsinfo.nih.gov. The most recent IAS-USA guidelines were published in the Journal of the American Medical Association (JAMA) in the summer of 2010.

Antiviral treatment options have primarily included combinations of two nucleoside analogue reverse transcriptase inhibitors (NRTI), often referred to as “nucs,” and one PI, typically with a low dose of Ritonavir, a PI used at low doses to increase the level of the principle PI being used, so called “boosting.”

Alternative, options include the use of two NRTIs with a nonnucleoside analogue reverse transcriptase inhibitor (NNRTI), the latter often called “non-nucs.” These NNRTI-containing combinations generally are easier to take than PI-containing combinations and tend to have different side effects. Recently, NRTIs were combined with the integrase inhibitor raltegravir with very good viral suppression and tolerability. This novel combination has now been approved by the Food and Drug Administration as another treatment option for those initiating therapy for the first time and is considered along with NNRTIs and PIs as one of the preferred options. Continue reading →

Cystic Fibrosis Tests

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How is Cystic Fibrosis diagnosed?

Cystic Fibrosis is increasingly being diagnosed through screening, but some babies and older children (and even adults) are diagnosed following unexplained illness.

There are three types of screening for Cystic Fibrosis: newborn screening, carrier testing and antenatal testing.

Newborn Testing:

The test is a heel-prick to sample blood as part of the normal Guthrie test carried out on all children. The sooner cystic fibrosis is diagnosed, the sooner appropriate treatment can begin.

heelprick test Continue reading →