The new drugs against HIV / AIDS appeared after 2007 have led to a reduction in a very significant number of patients who did not respond to the first combined treatment of three or more drugs, as was revealed by a study of 91,764 patients of several Western European countries that was published this month by The Lancet Infectious Diseases . The drug also reduced the number of new AIDS cases among people with the virus.

New HIV drugs show a clear improvement for patients who did not respond to the first treatments

One of the groups that participated in the study is cohort Pisces, a group  of 11 hospitals of Catalonia and the Balearic Islands.  Pisces participation was coordinated in this study by Dr. Daniel Podzamczer, director of the Unit of HIV / AIDS Service of Infectious Diseases at the University Hospital of Bellvitge and researcher of the research group of infectious disease and antibiotic sensitivity of IDIBELL. Pisces  coordinator is Dr. Jordi Casabona, director of the Center for Epidemiologic Studies of Sexually Transmitted Infections and AIDS in Catalonia (CEEISCAT).

In 1996 began the systematic administration of combined treatments with three or more drugs, which in most cases, allowed to slow the progression of the virus. However, a number of patients (between 3% and 4%) failed on all three families of drugs initially available.

In later years, particularly after 2007, alternative new drugs have emerged. To see if these new drugs had helped reduce resistance to the treatment and improved the development of the disease, was launched  the initiative Pursuing Later Treatment Option II (PLATO II), in which contributed a large number of European centers, and is included in a broader initiative called the Collaboration of Observational HIV Epidemiological Research Europe (COHERE).

The main objective of this study was to observe the evolution between 2000 and 2009, of the number of people with pharmacological failure, however, they had a level of less than 50 RNA copies of the aids virus per milliliter of plasma. Other objectives were to observe the evolution of AIDS incidence and mortality.

In 2009, the proportion of patients who had a low virological level after the pharmacological failure was 57.9%, next only 19 , 5% in 2000.During the years 2000, 2001 and 2002, the incidence of AIDS defining events was 7.7 per 100 patients / year. However, in 2008 fell to 2.3, and in 2009 to just 1.2. The gross death rate was 4% patients / year between 2000 and 2002, and of only 1, 4% in 2009.

The positive trends identified in the study are the result of the effort of many parties involved in improving the care for people with HIV. The increasing availability of new drugs in existing classes (such as new protease inhibitors and new inhibitors of reverse transcriptase non-nucleoside analog) has made ​​it possible not to be taking a high number of pills, or follow a rigid schedule . In addition, new families of drugs have emerged.

However, there are still some people with drug failure that cannot reduce their viral load, and patients who start antiretroviral therapy now no longer receive the same agents used in previous years, so that the profiles of resistance will change and will have to continue developing new drugs.

December 2011

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