IAS Conference Includes Findings from Asian Investigators
October 2003—In July, three participating clinicians in the TREAT Asia network presented research findings at the 2nd International AIDS Society Conference on HIV/AIDS Pathogenesis and Treatment in Paris.
Dr. Sanjay Pujari
Dr. Sanjay Pujari of the Ruby Hall Clinic in Pune, India, presented data from the country’s largest study to date observing the safety and immunological effectiveness of simplified fixed-dose nevirapine-based combination therapy.
Close to 1,000 treatment-naïve patients were enrolled in Pune and at another HIV clinic in Ahmedabad. The study revealed that fixed-dose nevirapine-based highly active antiretroviral therapy (HAART) showed good safety and lasting immunological improvement. Dr. Pujari suggested that the study’s success was at least partly explained by the use of a simplified treatment regimen.
Dr. Pujari was also part of a team that showed total lymphocyte count (TLC) to be a poor surrogate for CD4 counts among asymptomatic HIV-infected patients. The World Health Organization (WHO) has not advocated the use of TLC counts for initiating antiretroviral therapy in resource-limited environments, and data from the study validates the WHO guidelines.
Also in India, Dr. N. Kumarasamy of the Y.R.G. Centre for AIDS Research and Education (YRG CARE), Chennai (see page 6), led a group investigating the frequency of immune reconstitution (IRS) syndrome among subjects initiating generic HAART regimens who were coinfected with HIV and tuberculosis. IRS is defined as new lymph node enlargement, localized tenderness and/or fever, with no other etiology identified after initiation of HAART.
The research team found that with increased access to antiretroviral therapy and the rising incidence of opportunistic infections in the developing world, clinicians must understand the epidemiology and clinical characteristics of IRS and ameliorate symptoms without compromising clinical care. The study also concluded that there is an urgent need to develop guidelines for initiation of antiretroviral therapy in the context of opportunistic infections in the developing world.
Dr. N. Kumarasamy
Dr. Adeeba Kamarulzaman of the University of Malaya Medical Center in Kuala Lumpur, Malaysia, presented data from a study she led to define the clinical spectrum of AIDS-related disease and determine factors predicting natural history and progression of HIV disease in a developing country setting. The study, which followed 962 patients attending two HIV units in Kuala Lumpur between 1990 and 2002, showed that the most common opportunistic infections were tuberculosis, Pneumocystis carinii pneumonia, and toxoplasmosis. The study showed a clinical spectrum of AIDS-related disease similar to that seen in other developing countries in the region and underscored the need for early diagnosis and improved access to antiretroviral therapy to improve disease survival in HIV-infected patients in developing countries.