S 19

HAART AND ITS CONTROVERSIES

A. Meliço Silvestre
Direcção do Departamento de Doenças Infecciosas, Hospitais da Universidade de Coimbra, Portugal

Since the beginning of HAART clinical practice, we are now, seven years after, trying to analyse the results and discuss the controversial of this important improvement, trying to maximize results for the welfare of our patients and dealing with viral load/CD4+ count paradigm.
Meanwhile, we all know, clinicians and researchers, the multitude of unanswered questions. When so many questions are placed, we deliberately stress the experience and modest contribution of our clinical and basic research team.
The virus is evolving. In Portugal we are facing non-B subtypes and recombinant strains, not knowing until now the effectiveness of our drugs over them. Could this lead to the begging of new epidemics?
The viral proteins, stressed by antiretrovirals, are mutating and resisting to medica-
tion … but is this so linear?
The apparent efficacy of HAART can not destroy viral sanctuaries, being calculated that we probably need more than 60 years to eradicate the infection. This led us to Blood Brain Barrier and what is behind AIDS dementia and PML …
What about patient genetic factors? What is the clinical importance of MDR1 gene expression on antiretrovirals cell penetration?
Another problem that we face is the antiretrovirals adherence. New easily taken regimens are entering the market, but aren’t we forgetting social/psychological patients’ support?
And when we achieve to constrain the virus and we have an immune reconstitution syndrome?
And what about metabolic disorders?
We clinicians and researchers face an enormous task ... always underlining that our main thought is the HIV patient.