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Author Topic: BE CAREFUL ABOUT GOING TO A.H.F.  (Read 1419 times)

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Offline cutePOZguy

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« on: August 07, 2009, 04:05:04 PM »
Hello, some of my friends and I have been going to AHF and we have noticed that our doctors (particularly the ones in Beverly Hills) are pushing their patients to be on EPZICOM.  This drug was recently shown to cause heart attacks.  Also this drug was not as good at controlling viral loads as TRUVADA.  If you go to AHF, and your doctor tries to put you on EPZICOM stand up for yourself.  The drug company that makes EPZICOM is always in AHF's office and giving $$ to them.  All I'm saying is be careful.....please forward this on to your friends if they go to AHF. 

Offline Inchlingblue

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« Reply #1 on: August 07, 2009, 07:48:06 PM »
There are new studies that have put into doubt whether abacavir (part of Epzicom) is in fact a heart risk and also put into doubt whether Epzicom is less effective than Truvada. The jury is still out with these things.

That doesn't mean that Epzicom is right for everyone, nor should it nor any other drug be "pushed" on patients, but Epzicom is a perfectly good HIV drug, in fact it's one of the better ones. I know people on it who are doing very well.

Ziagen and the Risk of Heart Disease

Q: Now, on to a drug that has been talked about so much this year, that is Ziagen [abacavir, ABC,]. The big question remains: Does it pose a heart disease risk or not? Every scientific meeting held during the last year or so seemed to bring us a new take on this. Dr. Gallant, what was the news from IAS?

This has been a very interesting controversy. We first heard the data from the D:A:D study, and then the SMART study, and then the French Hospital Database study, saying that abacavir increased the risk of heart attack.19-21

The data became so overwhelming that people finally said, "Well, I guess it does." But everybody acknowledged that the data came from these observational cohort studies that have their limitations. They weren't randomized trials. But it just seemed like study after study after study was showing this association. You just couldn't ignore it.

The DHHS [U.S. Department of Health and Human Services] guidelines reacted, in part, to that information and switched abacavir from a preferred nucleoside to an alternative nucleoside.22 It was also based on ACTG 5202, which suggested that Epzicom was less effective than Truvada at high viral loads.23

But at this conference, now we have some data going the other way. There's a very large study from the Veteran's Administration database, which initially did find a higher rate of MI [myocardial infarction] with the use of abacavir.24 What they found was that if you controlled for two things, standard cardiac risk factors and chronic kidney disease, then that association between abacavir and heart attack essentially went away.

Their argument was that people with chronic kidney disease are much more likely to get abacavir because they can't take tenofovir, and people with chronic kidney disease are much more likely to have heart attacks. Thus, the reason you see this association between abacavir and MI is because you're taking the people at highest risk for heart attack and giving them abacavir.

At the same time, the investigators from the French Database study, which was presented at CROI in Montréal,21 also found an association but said if you corrected for things like substance abuse and injection drug use, the association went away.

I don't think this means that we have the answer. I don't think it invalidates the results of the other observational studies. We have to keep in mind that the methodology is different. The D:A:D study did, in fact, look at kidney disease. Even after adjusting for that, they still found an association. But they had a lot less kidney disease in their cohort.

I think this just reinvigorates the debate. It means that we don't know the answer yet. I'll be interested to see further analyses from the original studies, to see what kind of light that can shed on this controversy.

Q: So it's not over yet.

No, I don't think it's over yet. I'm sure there will be a defense of the original studies. We'll have to see the publication of this VA [U.S. Department of Veterans Affairs] study. I would also point out that the VA study did not look at exactly the same thing as the D:A:D study. The D:A:D study found an association with recent abacavir use, but the VA study didn't look at exactly that. Because their data is different, they don't necessarily have the ability to look at exactly the same analysis.

But I think it throws a little cold water on this. It means that we're a lot less certain about this association than we were a few months ago, after the Montréal conference.

Q: But the recommendations remain the same: If you have a preexisting risk for heart disease, then abacavir would not be the right choice.

It's not if you have a risk, but generally, multiple cardiac risk factors. The cardiac risk factors are high LDL [low-density lipoprotein] cholesterol, smoking, diabetes, hypertension, a strong family history of early heart disease -- things like that. If you have a number of those risk factors, the current recommendation is to try to avoid abacavir. But I think we just have to acknowledge that at this point we can't be certain whether what we've seen so far is a true risk with abacavir, or whether it's just a phenomenon of observational database analysis



High Viral Load Patients Equally Fine on Epzicom or Truvada

August 7, 2009

People who start antiretroviral treatment for the first time with a viral load over 100,000 do equally well on a regimen containing abacavir (found in Ziagen, Epzicom and Trizivir) as on a regimen containing tenofovir (found in Viread, Truvada and Atripla), according to a study published in the September 1 issue of The Journal of Infectious Diseases. These results counter a previously reported study that suggested abacavir—notably its Epzicom co-formulation with lamivudine—is less likely to keep viral load undetectable among people initiating HIV treatment with high viral loads.

Early results from the AIDS Clinical Trial Group (ACTG) study 5202, reported in August 2008, indicated that patients with viral loads above 100,000 upon starting a regimen containing Epzicom failed treatment faster than those taking Truvada (tenofovir plus emtricitabine). A subsequent analysis of several studies by the company that makes abacavir, GlaxoSmithKline (GSK), found no greater risk of early failure in people on their drug who’d started treatment with high viral loads, than in people on tenofovir.

To examine the potential for early virologic failure with abacavir, Loveleen Bansi, MSc, from the Royal Free & University College Medical School in London, and her colleagues looked at the medical records of 1,548 HIV-positive patients enrolled in the U.K. Collaborative HIV Cohort Study (UK-CHIC). In all, 1,136 of the participants started HIV treatment with an abacavir-containing regimen and 412 started therapy with a tenofovir-containing regimen. About 45 percent of the people taking abacavir started treatment with a viral load over 100,000.

When Bansi’s team accounted for variants such as CD4 count, age, sex and other drugs in the regimen, they found that people who took an abacavir-containing regimen had a similar drop in virus as people taking tenofovir—roughly 2 logs (99 percent). People who started treatment with very high viral loads—greater than 300,000—were less likely to have a virologic response to treatment, but this was true whether they took abacavir or tenofovir. In fact, people with high viral loads on abacavir had the same drops in viral load and the same degree of viral success at 24 and 48 weeks after starting treatment.

The authors acknowledge that their study, which simply looks at what happened in a group of HIV-positive people (called a cohort study), is not as rigorous as studies planned and conducted solely to compare the two drugs. However, the authors suggest that the new data, when viewed along with the results of controlled studies, add weight to the argument that people with high viral loads who start abacavir are likely to do well.


« Last Edit: August 07, 2009, 07:50:45 PM by Inchlingblue »


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