AIDS TREATMENTS STUDIED

By Emma Ross

AP 14 August 2000

London -- While new medicines have dramatically reduced the chances of HIV patients developing AIDS, a new study indicates the percentage who contract non-Hodgkins lymphoma has quadrupled since the drugs were introduced six years ago.

People infected with HIV are defined as having AIDS when their immune systems become so weak that they get one of 26 illnesses, including non-Hodgkins lymphoma, as well as pneumonia, brain infections and some other cancers.

Experts have known that the effectiveness of the new combination drug therapy, called highly active antiretrovirals, varies depending on which of the 26 AIDS-defining illnesses are involved. Some experts have reported suspicions the new therapy doesn't work as well for non-Hodgkins lymphoma as for the other diseases.

"This paper is probably the most compelling data to date to support that suspicion,'' Dr. Mark Jacobson, a professor and AIDS specialist at the University of California-San Francisco, said of the Danish study, published this week in the British medical journal The Lancet.

In defining whether an HIV sufferer has developed AIDS, the U.S. Centers for Disease Control also considers a drop in the blood levels of CD4 T cells - the immune system's key infection fighters - to a level below 200 per cubic millimeter of blood.

The highly active antiretrovirals were introduced in 1994 to help prevent HIV patients from progressing to AIDS. They inhibit the ability of HIV to reproduce itself in the blood, keeping down the amount of the virus in the body.

The cocktail has dramatically improved health and survival in the United States and Europe.

The Danish study of 7,300 European HIV patients found that even if patients' CD4 cell count dropped well below 200, the new combination therapy still protected them from AIDS-defining illnesses.

Dr. Badara Samb, care adviser at UNAIDS, a joint program of the United Nations and the World Health Organization, called that finding "encouraging.''

Dr. Jens Lundgren, a professor at the University of Copenhagen who led the study, said he found an overall drop in the progression from HIV to AIDS of more than 90 percent, and the decline was sustained year after year.

Lundgren also found that the number of HIV-positive people developing non-Hodgkins lymphoma, a cancer of the lymph glands, has declined among people taking the new drugs, but not by as much as other diseases.

That means the cancer makes up a larger proportion of AIDS diagnoses than it did before. In 1994, 4 percent of the progression from HIV to AIDS was due to non-Hodgkins lymphoma. By the end of the study, the disease accounted for 16 percent of AIDS diagnoses.

The study speculated that using the combination drug therapy earlier in the progression of HIV might prevent the cancer.