HAART at 10: an interview with Cal Cohen.
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Biomedical subjects
Publications and source records attributed to Cal Cohen.
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A leading AIDS physician looks at the advantages and disadvantages of once-a day treatment with two new fixed-dose combinations of previously approved drugs, for patients who are first starting antiretrovirals.
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The conclusion of Dr. Cohen's interview includes an in-depth look at current thinking on treatment interruption, strategies for highly treatment-experienced patients, and other topics from the recent Retroviruses conference.
We asked a leading AIDS physician to summarize some of the important treatment messages for physicians and patients, from the 10th Conference on Retroviruses and Opportunistic Infections, a major scientific meeting. Part 1 of the 2-part interview looks a starting antiretroviral therapy (including tenofovir vs. d4T, and efavirenz vs. nevirapine), new protease-inhibitor information, and antiretroviral drug toxicity.
This study evaluates the change in CD4(+) T cell counts among patients who achieved complete viral suppression and subsequently discontinued highly active antiretroviral therapy (HAART). We included 72 human immunodeficiency virus (HIV)-1-infected patients with plasma HIV RNA loads of <500 copies/mL for at least 3 months who then discontinued therapy for at least 12 weeks. The median CD4(+) T decay while off HAART was 16 cells/mm(3)/month (interquartile range, -6 to -34 cells/month). The mean follow-up after therapy ended was 45 weeks. The slope of the CD4(+) T cell decay was inversely correlated with the increase of CD4(+) T cells while receiving HAART, baseline virus load, CD4(+) T cell count at the time therapy was discontinued, age, and duration HIV RNA levels were undetectable. In a multiple regression analysis model, the increase of CD4(+) T cells while receiving therapy and age were independently associated with the rate of CD4(+) T cell loss.
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Dr. Cohen and others at the Community Research Initiative are studying a schedule of five days on certain antiretroviral regimens and two days off, for certain patients whose virus is well suppressed. The goal is to reduce side effects and cost, and to make the regimens easier to take. We asked about the results so far.