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Issue No. 1 | January 8, 2010

News and Features

DHHS Panel on Antiretroviral Guidelines for Adult and Adolescents Announces New Panel Members

The DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents (a Working Group of the Office of AIDS Research Advisory Council) is pleased to welcome five new members to the Panel. The new members will begin a 4-year term beginning February 2010.

New Scientific Members:

  • John T. Brooks, M.D., Centers for Disease Control and Prevention, Atlanta, GA
  • Richard W. Price, M.D., University of California-San Francisco, San Francisco, CA
  • Zelalem Temesgen, M.D., Mayo Clinic, Rochester, MN

New Community Members:

  • Lei Chou, Treatment Action Group, New York, NY
  • Jeff Taylor, Palm Springs, CA

The following members will be concluding their services to the Panel in February 2010. The Panel thanks them for their dedication and contributions over the years.

  • Judith Currier, M.D., University of California-Los Angeles, Los Angeles, CA
  • Morris Jackson, AIDS Project Los Angeles, Los Angeles, CA
  • Wilbert Jordan, M.D., M.P.H., OASIS HIV Clinic & Charles R Drew University, Los Angeles, CA
  • Renslow Sherer, M.D., University of Chicago, Chicago, IL

Study Suggests Combined Antiretroviral Therapy (cART) Decreased the Average Mortality Rate in HIV-Infected Individuals

“A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62[,]760 HIV-infected, therapy-naive individuals [were] followed for an average of 3.3 years. …Two thousand and thirty-nine individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval 0.41-0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22-0.37) for less than 100 cells/microl, 0.33 (0.25-0.44) for 100 to less than 200 cells/microl, 0.38 (0.28-0.52) for 200 to less than 350 cells/microl, 0.55 (0.41-0.74) for 350 to less than 500 cells/microl, and 0.77 (0.58-1.01) for 500 cells/microl or more. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49-0.67) for less than 1 year since initiation to 0.21 (0.14-0.31) for 5 years or more (P value for trend <0.001). …We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start of follow-up."

More information is available:

Study Suggests Genotypic Scoring Algorithm Optimizes Resistance Interpretations for Etravirine

“A multivariate analysis was performed to refine the initial etravirine [resistance-associated mutation] RAM list and improve the predictive value of genotypic resistance testing with regard to virologic response and relationship to phenotypic data. ...Week 24 data were pooled from the phase III studies with TMC125 to Demonstrate Undetectable viral load in patients Experienced with ARV Therapy (DUET). The effect of baseline resistance to etravirine on virologic response (<50 HIV-1 RNA copies/ml) was studied in patients not using de-novo enfuvirtide and excluding discontinuations for reasons other than virologic failure (n = 406). ...Clinical cutoffs for etravirine were established by analysis of covariance models and sliding fold change in 50% effective concentration (EC50) windows. ...Etravirine RAMs were identified as those associated with decreased virologic response/increased etravirine fold change in EC50. Relative weight factors were assigned to the etravirine RAMs using random forest and linear modeling techniques. ...Baseline etravirine fold change in EC50 predicted virologic response at week 24, with lower and preliminary upper clinical cutoffs of 3.0 and 13.0, respectively. A fold change in EC50 value above which etravirine provided little or no additional efficacy benefit could not be established. Seventeen etravirine RAMs were identified and attributed a relative weight factor accounting for the differential impact on etravirine fold change in EC50. Virologic response was a function of etravirine-weighted genotypic score. ...The weighted genotypic scoring algorithm optimizes resistance interpretations for etravirine and guides treatment decisions regarding its use in treatment-experienced patients.”

More information is available: