Federal Team Developing Treatment Principles for HIV Infection

The Office of AIDS Research (OAR) of the U.S. National Institutes of Health has selected a panel "to make recommendations regarding initiation of treatment; suppression of HIV replication; minimizing or preventing emergence of drug-resistant HIV variants; prolonging effectiveness of therapy; and addressing the public health consequences of transmission of multi-drug resistant variants."

"The panel's activities will involve a series of meetings and analysis of the most recent available data. The panel is expected to work over the next several months to develop these recommendations, which will help health care practitioners and HIV-infected individuals make informed decisions about treatment options. It is also anticipated that the recommendations of this panel will assist public and private health care payers in providing reimbursement for essential care for HIV-infected patients."

The "NIH Panel to Define Principles of Therapy of HIV Infection" has 24 members and is chaired by Charles Carpenter, M.D., of Providence, Rhode Island; its executive secretary is Mark Feinberg, M.D., Ph.D., of OAR. There are two community representatives: Dawn Averitt, of Women's Information Service & Exchange (WISE) of Atlanta, and Mark Harrington of Treatment Action Group (TAG) of New York. Three panelists are from Europe and Australia, with most of the U.S. members from the East Coast.

The panel's first meeting is November 13 and 14 in Washington, during which the panelists will hear more than 30 presentations on the current state of scientific knowledge, focusing mainly on recent information learned too late for presentation at the Vancouver international conference in July.

The meeting occurs after this issue of AIDS TREATMENT NEWS goes to press, and OAR does not plan to issue a report of this particular meeting (clearly there will be a report from the panel eventually). But the list of presentations (from the draft agenda released by OAR) gives an excellent overview of the state of the science today, of some of the issues considered most relevant to designing the best possible treatments for HIV disease. The titles are listed chronologically from a November 11 draft agenda, but because of lack of space we did not include the names and affiliations of the presenters.

Wednesday November 13, 1996:

Session I: Virus and T Cell Population Dynamics in HIV Infection

* HIV Replication Dynamics: Virus Turnover and Implications for Antiviral Therapy

* Analysis of Tissue Reservoirs of HIV Infection

* Human T Cell Populations in HIV-Infected and Uninfected Individuals

* Regenerative Potential of Human T Cell Populations

* Natural History of T Cell Depletion in AIDS

* Maintenance and Loss of T Cell Homeostasis in HIV Infection

* T Cell Replication Senescence in HIV Infection

Session II: The Relationship Between HIV Replication and Disease Progression

* Performance Characteristics and Variability of the Quantiplex (bDNA) Assay for Plasma HIV-1 RNA

* Performance Characteristics and Variability of the Amplicor (RT-PCR) Assay for Plasma HIV-1 RNA

* Primary HIV-1 Infection and the Establishment of the Replication "Set Point"

* Serum HIV-1 RNA Levels and Progression to AIDS

* Relationship between Plasma and Cellular HIV-1 RNA Levels and Progression to AIDS

* Population-Based Studies of Plasma HIV-1 RNA Levels

* Plasma HIV-1 RNA Levels Predict Risk of Disease Progression and Survival

Section III: Relationship between Therapy-Induced Decreases in HIV-1 Replication and Protection from Disease Progression

* Correlation Between Decline in HIV-1 RNA Levels and Clinical Outcomes (2 presentations)

* Cross-Study Comparisons of Therapy-Induced Changes in Viral Load, CD4 T Cell Counts and Clinical Progression

Thursday November 14, 1996:

Session IV: Therapy-Induced Changes in CD4 T Cell Levels and Recovery of Immunologic Function

* The Magnitude and Limits of Therapy-Induced CD4 Cell Increases

* Recovery of T Cell Numbers and Function Following Antiviral Therapy

Session V: Strategies to Delay or Prevent Antiviral Drug Resistance

* Understanding and Overcoming HIV-1 Antiviral Drug Resistance

* Combination Antiviral Therapy and Antiviral Drug Resistance

* Detection of Drug-Resistant HIV Variants (2 sessions)

Session VI: Protease Inhibitors Resistance and Cross Resistance

* HIV-1 Protease Inhibitors Resistance (2 sessions)

Session VII: Combination Antiviral Therapy of Established HIV-1 Infection

* Combination Therapy of Primary HIV-1 Infection

* Antiviral Therapy of Primary HIV-1 Infection

* Combination Nucleoside Analog Therapy

* Combination Nucleoside Therapy: Recent Experience and Future Prospects

* Combination Therapy and Non-Nucleoside RT Inhibitors

* Long-Term Suppression of HIV-1 Replication by Combination Therapy

* Recent Results with Protease Inhibitors

* New Antiviral Therapies (2 presentations)

* Closing Remarks