Perspective: Information, Inspiration and Advocacy for People Living with HIV/AIDS

A Recommendation PrOject Inform
For now, it is wise to assume that there was.
a good reason for the dosing schedule rec- Drug Delivery Conference
ommended when a drug was first approved.
People should stick to that schedule until I Over the last two years, Project Inform has become acutely aware
someone proves that a different schedule is of the difficulties many people face in using the treatments availtruly equivalent over the long term. Once
sufficient data exist that a simpler regimen able for HIV. Almost no one is satisfied with the number of pills
may be useful, it should be cautiously of- and pill-taking intervals required each day.
fered as an alternative by the sponsors -
not aggressively marketed - to people hav- The demands for careful adherence to dosing schedules are somewhat driven by the weaking trouble adhering to the proven, initial nesses of the drugs themselves - levels of the drugs in the blood rise and fall throughout
regimen. Then perhaps if long-term follow- the day between doses, leading to opportunities for the development of resistant virus. To
up proves true long-term clinical equiva- compensate, drugs are delivered at excessively high doses. While this may help maintain
lence, a time may come when the new dos- adequate levels throughout the day, it also contributes to toxicity. For many people,
ing may be recommended for standard use. taking a large quantity of pills is simply not possible because of nausea, wasting, or
damage to the intestinal tract. Still others fight a daily battle with diarrhea, which interThe desire for easier dosing regimens is not feres with uptake of the drugs into the blood.
a bad thing. But the goal should be achieved
the right way - by designing new and bet- At least some of these problems can be solved with new drug delivery technologies under
ter formulations, not just by changing the development by the highly specialized drug delivery industry. To facilitate change and new
labels on older drugs after rushed, short- opportunities in this area, Project Inform sponsored a meeting on October 16, 1997 to
term studies. Simply changing the label on explore the possibilities of using alternative drug delivery methods for HIV therapies.
an existing drug is a very tempting short I Entitled "Exploring New Technologies to Overcome the Challenges of HIV/AIDS Treatcut, but it is not necessarily in the real in- ments," sixty participants were invited, representing drug delivery companies, pharmaterests of people whose lives depend upon ceutical companies, government and AIDS treatment advocates. The goal of the meeting
long-term success of drug regimens. was to see if there might be opportunities to improve the utility of HIV-related therapies
Snote with the help of the new drug delivery technologies. In a sense, the meeting was also an
Finally, patients and physicians should n opportunity for "match-making" between companies which make drugs and companies
that switching one or another drug to twice which make better ways to deliver them. Working together, they may benefit people with
daily dosing doesn't necessarily simplify a HIV by improving the distribution of drugs over time in the body or finding ways to
persons daily routine. It can just as easily- bypass some of the obstacles which interfere with proper uptake of drugs. Some of the
complicate it. For example, if the other drug delivery systems discussed may be able to help people better adhere to their treatdrugs a person takes require a thrice-daily ment regimens by reducing the number of times people will have to take their medications
regimen, changing to a twice daily antiviral or by giving them ways to use the drugs in a less toxic and more tolerable fashion. Other
might result in a person now having 5 dis- techniques may allow drugs to specifically target certain cells, such as those in the lymph
tinct "drug taking" periods in the day. nodes or in the brain.
Project Inform urges anyone who is asked This type of work represents part of our efforts to influence the long-term development of
to participate in marketing surveys or fo- therapies for HIV disease. There may be no instant or immediate payoff in the form of a
cus groups on thissubject to consider the new mechanism for drug delivery, but over time we believe that meetings of this type will
more complex issues involved above and. make as much of an impact as new drugs themselves. Project Inform will continue to
beyond the simple desire for easier dosing. organize these kinds of meetings which foster collaboration to help prolong and improve
Simpler dosing is a reasonable objective, but the lives of people with HIV. U
should not come at the cost of the longterm durability of therapy. *
we The HIV Drug Book
Second edition!
Updated by the staff and volunteers of Project Inform and published by Pocket Books,
the second edition will be available in bookstores January 1998 with a new cover, a
~j~j3 1300new look and a lot of new information!
Over 30 new individual drug profiles...
Updated information and new articles...
A summary of the new guidelines on using anti-HIV drugs...

A discussion of Adherence to HAART...
And more.

PI PERSPECTIVE

I NUIVBER 23 NOVEIVBER 1997

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