Charles Farthing

In the Life: IAPAC Member Charles Farthing of Los Angeles, California

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In another study presented later in the same session, a triple nucleoside combination of ABC, 3TC, plus tenofovir (TDF) also failed to make the grade, according to Charles Farthing, MD, from the AIDS Healthcare Foundation in Los Angeles.He reported that of 19 patients in the study,11 (58 percent) had virologic failures, and only five had a virologic response."These preliminary results raise concerns about potency and efficacy of the once-daily combination in naive patients.Until further data are available, this regimen, especially once-daily, should be avoided," Farthing said.

According to Charles Farthing, MD, chair of IAPAC's ad hoc Norvir Advisory Committee, "Although most HIV specialists are not overly concerned about the transition, there may be many physicians throughout the world who have only a few patients on Norvir capsules and may prefer to seek expert medical opinion on transition issues.There is a need to supply these physicians, their patients, and the pharmacists who dispense prescriptions, with timely, accurate information upon which the success of any anti-AIDS therapy lies."

IAPAC's information system, the IAPAC Norvir Advisory, is a multi-prong system to provide physicians and pharmacists transition information via the association's Web site (http://www.iapac.org), fax, and/or direct mail.Farthing predicts the majority of concerned healthcare professionals and patients will access information through the new Norvir Advisory section of the IAPAC Web site, which was launched on Friday, August 27.IAPAC is currently registering physicians and pharmacists in a Norvir registry, through which IAPAC will notify them via e-mail when new information is posted on the Norvir section.

IAPAC is not enrolling patients on the Norvir registry, and is instead counting on local AIDS service organizations to serve as conduits for the IAPAC Norvir Advisory.The advisory will be translated into multiple languages.Spanish and Portuguese translations will be available in mid-September.

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Among the first features will be reviews and comments on algorithms being circulated among physicians that offer alternate antiviral regimen options, some of which Farthing characterizes as "potentially harmful to some patients."

The IAPAC Web site has been re-designed to accommodate the IAPAC Norvir Advisory.

That news and what it might mean for human LAV studies was debated in a pair of contrasting presentations in Geneva by Charles Farthing, MD, of IAPAC and Ruth Ruprecht of the Dana-Farber Cancer Institute.
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Farthing called LAV "the approach that we feel has the most likely chance of success of any of the candidate vaccines," and noted that IAPAC has had a very positive response to its call for volunteers for a LAV trial.

Farthing cited the well-publicized Australian case involving eight transfusion recipients who received HIV-infected blood from the same man, whose virus turned out to be missing the nef gene.Although some of the individuals eventually died from apparently non-AIDS-related causes, Farthing noted, "none have developed illness or significant immune suppression that can be attributed to HIV alone," in follow-up periods ranging up to 17 years after infection.This experience, he argued, "clearly shows that these people have been infected with a significantly attenuated strain of HIV ... Even if these patients go on to develop immunosuppression in the future, they clearly show that a nef -deleted strain of HIV is attenuated and relatively safe."

Farthing argued that more effort should go into LAV research.Lack of funding, he said, "is proving a problem in developing deleted HIV strains into purified vaccine preparations.Resource allocation seems to be all the wrong way around."

Farthing largely dismissed the monkey data that Ruprecht was about to present, much of which involved newborn monkeys.
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"I question the relevance of this data, especially the neonatal monkey data," Farthing argued."We never inject neonatal humans with live attenuated vaccines ...The adult monkey data is more concerning, but again may not be relevant.SIV is not HIV and monkeys are not humans."Farthing concluded that the safety concerns about human LAV trials "are being way overplayed."