October 2000 • Post-Assembly Edition • Dallas
HIV infection: no longer a death sentence
BY CINDY McCANSE
There's good news and bad news in the battle against HIV infection.
"There have been so many advances in the treatment of HIV that it now can be considered a chronic illness," said Patrick Morrow, M.D., of Dallas at the Sept. 22 AAFP Scientific Assembly mini-course, "HIV Management."
"This is no longer a death sentence, and, with proper management, every one of our HIV patients can live a normal and full life."
The key, Morrow explained, is knowing what therapeutic options are available and how to use them effectively.
Management of HIV-infected patients is a complex process that starts with appropriate screening. Knowing when to order diagnostic testing is essential to early detection, said Morrow. And physicians who don't routinely care for patients with HIV infection should enlist expert help.
Even then, there's a caveat.
Patrick Morrow, M.D.
"The difference between dogma and dog manure in HIV treatment is six months. So anything I tell you today may be wrong six months from now.""The difference between dogma and dog manure in HIV treatment is six months," Morrow said. "So anything I tell you today may be wrong six months from now."
The nearly 20 drugs currently used for HIV treatment are generally administered in standardized combinations. In medication-naïve patients, initial drug combinations usually consist of two nucleoside reverse transcriptase inhibitors plus a protease inhibitor; two NRTIs plus a non-nucleoside reverse transcriptase inhibitor; or three NRTIs. This type of regimen is known as highly active antiretroviral therapy, or HAART.
Patient adherence is key, Morrow added. Physicians must stress the importance of following the therapeutic regimen and educate patients regarding the potential consequences of noncompliance.
Still, viral mutations can cause one drug or another to lose effectiveness. Genotype testing can identify these mutations, allowing the physician to determine which drug is failing and adjust therapy accordingly.
Successful treatment with some HAART regimens is not without its costs. Body fat redistribution and lipodystrophy are being seen with increasing frequency. And the most recent apparent side effect -- avascular necrosis of the hip -- currently has the experts stumped.
Not good news, surely. But given the advances made in HIV care to date, it seems safe to say that these obstacles, too, can be overcome.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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