International Conference: Major Themes

Here is a short list of some of the major treatment-related ideas that
were prominent at the conference. These are only listed here, and will
be covered in detail later.
* The movement toward early treatment is continuing -- partly because
of new evidence of benefit from antiretroviral treatment at T-helper
cell levels above 500, partly because better data now available is
showing a clear correlation between viral load and disease severity,
emphasizing that HIV disease should be treated primarily as a viral
illness.
* The movement toward combination therapy continues, with new data on
the combination of AZT and ddI, and evidence that combination treatment
can work better than alternating the same drugs.
* The drug d4T, now in large trials, is generating interest because it
may be more widely available soon through an expanded-access program.
It may be more beneficial for some patients than AZT or ddI, but it is
not yet clear what other drugs would work well in combination with d4T.
* Researchers have long sought combination treatments that would attack
the virus at different points in its life cycle. Now there is also
interest in drug combinations that attack the same point, especially
reverse transcriptase (e.g., AZT, ddI, ddC, and others). Researchers
suspect that the different drugs working together might put so many
constraints on the virus that mutants able to survive all the drugs may
no longer be able to reproduce efficiently and cause disease.
* There is also a possibility that one mutation may be making the virus
worse as HIV disease progresses. The more dangerous virus is called
syncytia inducing (SI), because it causes cells to merge into giant
cells in test-tube studies. The SI variant may also be much less
susceptible to AZT than other strains of HIV. It may be responsible for
the sudden drop in T-helper count which is seen in some patients. But
not everyone agrees that this virus is responsible for more serious
disease.
* A controversial but potentially important report added weight to the
theory that acyclovir may help to improve AIDS survival, although the
mechanism by which it could do so is unknown.
* Much information was presented on the practical management of various
opportunistic diseases, as well as on a number of experimental drugs
for these infections, and for HIV.