Primary Infection
Volunteer blood donors with indeterminate HIV Western blot tests seldom prove to be HIV-infected. In circumstances in which the subjects have greater risk for HIV infection, however, this is not true. Twenty-three (79%) of 29 state prison inmates with follow-up testing after indeterminate results proved to have seroconverted. (Abstract 580.) This study is a manifestation of the critical role of the pretest probability in the evaluation of any test result.
An inevitable problem, first recognized a number of years ago, is that of transmission of viral strains with existing resistance to existing antiretrovirals. HIV strains from three (10%) of 30 1995-1996 New York City volunteer blood donors found to be recently infected, but not previously treated, demonstrated mutations in their reverse transcriptase genes associated with antiretroviral resistance (ZDV in 2, nevirapine in 1). (Abstract 672.)
HIV from six (11.1%) of 28 recently infected (between 1993 and 1997) antiretroviral-naïve patients had reverse transcriptase gene mutations associated with ZDV resistance; none had ddI-associated resistance mutations. Mutations associated with protease inhibitor selective pressure were even more common. (Abstract 675.)
Primary nucleoside analog resistance (mostly to ZDV) in Spain was found in 13% of cases in 1997, the same proportion as in 1993. (Abstract 673.) It would be nice to believe that, as in this study, the incidence of primary drug resistance is not increasing-but I doubt it.
A number of studies demonstrated the virological efficacy of aggressive treatment of HIV infection soon after seroconversion. (Abstracts 167, 524, 531, 582, 583, 585, 587.)
Which of the following is correct?
a. Current evidence indicates that 3TC (lamivudine, Epivir) and ZDV (AZT, zidovudine, Retrovir) should never be used together.
b. Current evidence indicates that d4T (stavudine, Zerit) should never be used together.
c. Current evidence indicates that 3TC (lamivudine, Epivir) and ZDV (AZT, zidovudine, Retrovir) should never be administered together with indinavir (Crixivan).
d. Current evidence indicates that ZDV (AZT, zidovudine, Retrovir) and d4T (stavudine, Zerit) should not be used in combination.
Which of the following is correct?
a. The saquinavir soft gel capsule formulation (Fortovase) has better bioavailability after oral administration relative to the saquinavir hard gel capsule formulation (Invirase).
b. Coadministration of the saquinavir soft gel capsule formulation (Fortovase) together with nelfinavir results in markedly decreased area under the curve (AUC) of the former.
c. Hepatic disease is associated with reduced AUC of ritonavir in single-dose studies.
d. The administration of hydroxyurea together with ddI (didanosine, Videx) and d4T is ineffective in reducing viral load but does cause marked increases in CD4+ lymphocyte counts.
It has been suggested that, in a patient failing protease inhibitor therapy who has no remaining alternatives, continued administration of the failing protease inhibitor may still provide benefit.
a. True
b. False
Of those patients in abstract 410 receiving protease inhibitor therapy, how many developed lipodystrophy after a mean of 10 months?
a. 50%
b. 64%
c. 87%
d. 12%
e. 9%
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