Improving the Management of HIV Disease Vol. 6, no. 5 [World Conference on AIDS (12th: 1998: Geneva)]

QUESTIONS TO THE ANTIRETROVIRAL THERAPY AND RESISTANCE TESTING PANELS
QUESTIONS TO THE ANTIRETROVIRAL THERAPY
AND RESISTANCE TESTING PANELS

At the symposium in Geneva, the approximately 3000 participants were invited to submit questions for the Antiretroviral
Therapy and Resistance Testing panels to address. It would
have been impossible to answer all the submitted questions, but
we have attempted to address each of the major scenarios/problems presented in the questions submitted. Questions and
responses have been grouped into categories reflecting the major
issues raised.
Some of the questions raise issues for which there are no scientifically valid answers at this time. The panels have based
their responses on basic science and clinical trial data where
they are available, as well as on their own interpretations of
available data. Thus, the different members of the panel may

have different opinions or recommendations. These observations
indicate that many of the questions were, quite appropriately,
right on the cusp of advancing knowledge in this field, and that
there is still a great deal to be learned about the optimum use of
the therapeutic agents that are already at hand.
Because of the continued evolution of treatment of HIV disease, the IAS-USA Panels will continue to provide updated recommendations at a pace consistent with the availability of new
scientifically valid data. The comments below are the opinions
and recommendations of the individual panel members and do
not represent a consensus of either of the International AIDS
Society-USA panels. Rather, these discussions are meant to provide
feedback on some of the complicated issues involved.

1ACUEIFETO

thought to be the standard of therapy at
all stages of the disease over the last couple of years. Initially, the results of the
INCAS trial evaluating nevirapine and,
more recently, confirmatory results from
trials evaluating delavirdine and
efavirenz have further opened the door
for us to consider 2 nRTIs plus an NNRTI
as a potential treatment option. Beyond
that, early data presented by Margaret
Fischl at the Geneva conference highlighted the possibility of using triple
nRTI regimens (eg, zidovudine/lamivudine/abacavir) from early clinical testing
with similar results. Similarly, the issue
remains controversial in the area of primary HIV infection where unfortunately
very little controlled data exist on which
to base a recommendation. At this time,
therefore, our patients with primary HIV
infection who are not willing or able to

participate in randomized clinical trials
are offered triple-drug therapy using the
same principles that apply to initiation of
therapy in chronic HIV infection.

DR MONTANER: There is considerable
controversy regarding the best approach
to the management of HIV infection in
antiretroviral therapy-naive individuals.
Triple-drug combination with 2 nRTIs
and a potent protease inhibitor was

DR YENI: Interesting preliminary results
have been obtained in treating a small
number of patients with HIV primary
infection by a combination regimen
including didanosine, hydroxyurea, and

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VOLUME 6, OCTOBER 1998