March 28, 2024
BANGOR DAILY NEWS (BANGOR, MAINE

New AIDS guidelines target drug confusion> Treatment combinations a dilemma for doctors

WASHINGTON — New federal AIDS treatment guidelines may help end confusion among doctors and patients who must make life-and-death choices among 11 antiviral drugs that can be taken in 320 combinations.

Improper use of the AIDS drugs, experts warned Thursday at a news conference, can “do more harm than good.”

“We have to make sure that practitioners know these are the standards of care,” said Dr. John G. Bartlett, a Johns Hopkins University medical professor and co-chairman of a panel that drew up the guidelines. “There have been mistakes made in the past.”

The guidelines detail when patients infected with HIV should be started on the demanding and expensive three-drug cocktail that has been successful in suppressing the disease in thousands of patients. It also suggests what doctors and patients should do if a selected drug combination fails to work.

“Considerable uncertainty exists among patients and their physicians” about when and how best to use new HIV drugs, said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and co-chairman of the guidelines committee.

Doctors, he said, are uncertain when to start treatment for patients infected with HIV, the virus that causes AIDS; which drugs to use; how to monitor the effects; and what to do if the treatment fails.

“There has been confusion over the use of these drugs,” said Dr. Eric P. Goosby, director of HIV-AIDS policy for the Health and Human Services Department. “Physicians without expert guidance are at risk of unintentionally doing harm.”

Officials of the AIDS Action Council, an organization representing HIV patients, applauded the guidelines but said they are meaningless unless the government assures that all patients can get the expensive drugs and other treatment they require.

“The federal government and society at large needs to assure that the hope of this therapy is available to all people with HIV,” said Joe Zuniga, an AIDS spokesman.

He noted that the guidelines call for aggressive treatment with the expensive drugs early in the disease, but that federal funds are not available to many patients until they actually develop AIDS, a late stage of HIV infection.

The guidelines were prompted by clinical studies proving that a combination of three drugs offers the best hope of suppressing the virus and helping HIV patients maintain a healthy immune system. But sorting out which of the many drug combinations are best for which type of patients has added complexity and confusion to HIV treatment, the experts said.


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