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1996-02-27
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Document 0742
DOCN M9630742
TI HIV viral load quantification, HIV resistance, and antiretroviral
therapy.
DT 9603
AU Katzenstein DA; Holodniy M; Stanford University School of Medicine,
California, USA.
SO AIDS Clin Rev. 1995-96;:277-303. Unique Identifier : AIDSLINE
MED/96089203
AB We are moving rapidly beyond a black box understanding of the
pathogenesis of HIV. The sites of virus replication, the molecular
regulation of virus production in the host, and the dynamics between
productive virus infection and immunological and clinical events are
areas of intense study using powerful new tools. The quantitation of
virus load and genetic characterization of replicating virus has
important implications for the development and evaluation of drugs and
treatment strategies for HIV. As new compounds are introduced, their
ability to reduce virus load in vivo has become a primary consideration
in the decision to initiate large efficacy trials and may soon be used,
in combination with other markers, in the licensing of new agents. In
parallel, rapid molecular evaluation of virus from patients, targeting
those who break through drug-induced suppression, provides an
explanation for the failure of drugs to sustain an effect on virus load.
This approach has compressed the process of drug evaluation and set the
stage for the evaluation of complex combinations and sequences of drugs
to maintain suppression of virus and prevent the development of drug
resistance. The most controversial question for the next few years is
whether the measurement of virus load or detection of drug resistance
can be incorporated into the practice of medicine and the management of
individual patients. There is evidence that changes in virus load are
the most proximate markers of drug response and that detection of
resistance mutations can predict clinical and immunological decline.
However, the window of time between a change in load or the development
of drug resistance and a decline in CD4 cells is relatively short. With
dideoxynucleoside therapies, a CD4 cell decline follows a rise in virus
load or development of resistance within 3-6 months. In early studies
with protease inhibitors and nonnucleoside reverse transcriptase
inhibitors, the development of resistance and a return to baseline of
virus load may occur within 2-3 months, mirrored by a fall in CD4 cells.
The challenge to investigators is how to best use these new tools to
determine whether changes or additions in therapy, initiated on the
basis of virological measurements, result in more effective management
of disease.
DE Antiviral Agents/*THERAPEUTIC USE Drug Resistance, Microbial DNA,
Viral/ANALYSIS Human HIV/DRUG EFFECTS/*ISOLATION & PURIF HIV Core
Protein p24/ANALYSIS HIV Infections/DRUG THERAPY/*VIROLOGY Lymph
Nodes/VIROLOGY RNA, Viral/ANALYSIS JOURNAL ARTICLE REVIEW REVIEW,
ACADEMIC
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).