Professional Documents
Culture Documents
BMJ 2001;322;1410-1412
doi:10.1136/bmj.322.7299.1410
These include:
References
1 online articles that cite this article can be accessed at:
http://bmj.com/cgi/content/full/322/7299/1410#otherarticles
Rapid responses You can respond to this article at:
http://bmj.com/cgi/eletter-submit/322/7299/1410
Email alerting Receive free email alerts when new articles cite this article - sign up in the box at
service the top right corner of the article
Topic collections Articles on similar topics can be found in the following collections
Notes
ABC of AIDS
Antiretroviral drugs
Ian V D Weller, I G Williams
Drug toxicities
The tolerability and side effects of a combination regimen is
very important in determining the antiviral response. In clinical Drug toxicities
practice 40-50% of patients will not have sustained falls in Drug Toxicity
plasma viral load by one year of therapy and a major factor Nucleoside reverse transcriptase inhibitors
contributing to this is poor tolerability. Class associated Lactic acidosis
Hepatitic steatosis
Lipodystrophy (peripheral fat wasting)
Future agents Drug specific:
For the reasons of poor tolerability, suboptimal antiviral Zidovudine Bone marrow suppression, nausea, vomiting,
potency, and long term drug toxicity, it is important that new myopathy
antiretroviral agents and therapeutic strategies are developed Stavudine Peripheral neuropathy, hepatitis
and evaluated. New formulations of current drugs which Zalcitabine Peripheral neuropathy, mouth ulcers
improve tolerability and reduce pill burden will help to improve Didanosine Pancreatitis, dry mouth, peripheral neuropathy
adherence in patients. New protease and reverse transcriptase Lamivudine Few side effects
inhibitors which in vitro appear to be effective against viral Abacavir Hypersensitivity reaction, nausea
isolates which are resistant to different drugs are currently Non-nucleoside reverse transcriptase inhibitors
undergoing clinical trials. Whether these agents will prove to be Nevirapine Rash, hepatitis, Steven-Johnson syndrome
clinically effective will be important in treating those patients Efavirenz Rash, dysphoria, mood changes, vivid dreams,
who have previously failed combination therapies. hypercholesterolaemia
New classes of drugs are also being developed. Fusion Protease inhibitors
inhibitors which block the activity of the GP41 viral Class specific Lipodystrophy (fat wasting or accumulation)
transmembrane protein are in Phase III clinical trials and are Hyperlipidaemia, diabetes mellitus
likely to be the first new class of drug to reach the bedside. Drug specific:
As well as specific drugs that inhibit targets in the viral Nelfinavir Diarrhoea, rash
replication cycle, immunotherapeutic approaches are also being Saquinavir Few side effects
assessed. Treatment with cycles of the cytokine interleukin 2 Indinavir Hyperbilirubinaemia, nephrolithiasis, nail
results in substantial increase in CD4 counts but has little effect changes, dry skin
on plasma viral load levels. Interleukin 2 may also improve Ritonavir Perioral dysathesia, flushing, hepatitis,
immune responses to HIV and a large randomised international diarrhoea, nausea, vomiting
trial is under way to assess its efficacy in combination with Amprenavir Rash, nausea, diarrhoea
effective antiretroviral combination regimens. Therapeutic Lopinavir Diarrhoea
vaccines are also under evaluation which might improve specific
immune responses and assist immunological control of HIV
replication. Their clinical effectiveness remains uncertain.
Few areas of medicine have seen such dramatic changes in
treatment, with a resulting reduction in morbidity and mortality,
as there has been in the management of HIV infection. It is very
likely that therapeutic options will continue to improve,
although the long term efficacy of treatment over many years
still remains uncertain. BMJ 2001;322:1410-2
In a paper read before the Royal Statistical Society on the State meet in the dram shop, they consider it a mark of good fellowship
Monopoly of Spirits in Russia, the author, Mr. Alexis Raffalovich, to drink until all the party are under the table. Till quite recently
gives some interesting information as to the drinking habits of the publicans, it is alleged, did their best to stimulate and
the agricultural classes, who constitute about 90 per cent of the encourage this excessive drinking for the sake of the profit they
population, and as to the stringent efforts of the Czar’s made out of it. But five years ago the Government took the
Government to control and reform them. The Russian peasant, it matter seriously in hand, shut up 90 per cent of the dram shops
appears, drinks rarely, but when opportunity offers he consumes in country places, and 74 per cent of those in the towns, and
large quantities of intoxicating drinks, and when in a state of established a Government monopoly in the sale of spirits, at a
drunkenness he spends his last penny, and often even pawns his total cost of 40 millions of roubles.
clothes in order to get more drink. When he and his neighbours (BMJ 1901;i:295)