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HIV Weekly 18th Nov

In this issue:

HIV treatment – when to start treatment
HIV treatment – darunavir monotherapy
Hepatitis C – infections continuing to increase amongst HIV-positive gay men
TB – still a major health issue for people with HIV
HIV treatment – when to start treatment Read More

HIV Weekly 11th November 2010

In this issue:

HIV treatment as prevention
Side-effects of HIV treatment – bone loss
Side-effects of HIV treatment – treatment for facial wasting
HIV treatment as prevention Read More

Sexual Health Services Redesign Consultation Questionnaire

NHS Hampshire is currently redesigning sexual health services across Hampshire. The aim of the redesign is to improve access to local services, providing more services in GP practices and community pharmacy as well as integrating specialist GUM services (for the testing & treatment of sexually transmitted infections) with specialist contraception services into one service.

By integrating services we aim to reduce the distance you may need to travel and reduce the number of appointments that you may need, by providing services in one location and providing care closer to where you live.

Your views are important to us as we want to design services that are useful to you. This survey should take about 10 minutes to complete. Read More

Sexual Health Services Redesign Consultation

Your views are important to us as we want to design services that are useful to you. This survey should take about 10 minutes to complete. Read More

HIV Weekly 3rd November 2010

HIV and hepatitis
HIV and hepatitis C – the epidemic in France
HIV and hepatitis C – predicting the success of treatment
Hepatitis B – vaccination
HIV and hepatitis
All the reports in this edition of HIV Weekly are concerned with hepatitis.

Many people with HIV also have hepatitis B or hepatitis C. This is often referred to as ‘co-infection’. The liver disease that these infections can cause is now a major cause of illness and death in co-infected patients. Read More

HIV Weekly 27th October 2010

HIV treatment – darunavir works well in treatment-experienced patients
HIV treatment – saquinavir side-effect warning
HIV and sexual health – treatment of syphilis
HIV treatment – darunavir works well in treatment-experienced patients

There have been some big improvements in HIV treatment and care in recent years. Thanks to these, the aim of treatment for most patients is an undetectable viral load.

An important treatment option for those who have a lot of experience of HIV therapy is the protease inhibitor darunavir (Prezista).

Its power is boosted by taking it with a small dose of a second protease inhibitor called ritonavir (Norvir).

Clinical trials showed that including darunavir in an HIV treatment option was safe and effective in very treatment-experienced patients. The best results are seen when it’s combined with other drugs that work against HIV. Darunavir has also been approved for people starting HIV treatment for the first time.

But people in clinical trials usually receive a lot of support and are intensively monitored. Drugs don’t always have such good results when used in routine HIV care.

Researchers therefore wanted to see how effective darunavir was at suppressing viral load in 130 treatment-experienced Swiss patients who had received the drug as part of their HIV therapy.

The patients had taken a lot of anti-HIV drugs in the past. Many had HIV with some form of resistance to darunavir.

However, after a year of treatment, viral load was undetectable in 80% of patients. This compared to 45% in clinical trials. Having a detectable viral load was associated with poor treatment adherence, and with previous treatment with the protease inhibitors fosamprenavir or amprenavir (Agenerase or Telzir) and saquinavir (Invirase).

The drug was safe – only a small number of patients stopped taking it because of side-effects.

Read the full news story on our website here or visit the journal website to view the original article here.

HIV treatment – saquinavir side-effect warning
All medicines – including those used to treat HIV – can cause side-effects.

Some protease inhibitors have been associated with an irregular heartbeat. It’s already known that this is the case with saquinavir/ritonavir.

Now drug regulatory authorities in both the US and Europe have issued a strengthened warning about the heart rhythm disturbances that can be caused by ritonavir-boosted saquinavir (Invirase).

Although this side-effect is rare, it’s now recommended that all patients should have an ECG examination to monitor the health of their heart before they start treatment with saquinavir.

Medicine regulators in the US have also made specific recommendations about heart rhythm and treatment with saquinavir.

They recommend that anyone taking the drug should: “Seek immediate care if you experience an abnormal heart rate or rhythm or other symptoms including dizziness, lightheadedness, fainting or heart palpitations.”

European regulators have also made specific recommendations about saquinavir doses for those starting HIV treatment for the first time.

These state that the dose of saquinavir for the first week of treatment will be reduced from 1000mg twice daily to 500mg twice daily. This dosage adjustment is not necessary in patients who are switching from other antiretroviral drugs; the European Medicines Agency says the risk of an irregular heartbeat is greatest in people who have never taken antiretroviral drugs before.

For more information on side-effects you can read our information booklet on our website here.

HIV and sexual health – treatment of syphilis
High rates of sexually transmitted infections, including syphilis, have been seen in people with HIV.

Syphilis is a bacterial infection which can cause serious health problems if left untreated.

However, it can be successfully treated with antibiotics.

The usual treatment is injections into the muscle (usually the buttocks) of a long-lasting form of penicillin called benzathine penicillin G. Other antibiotics also work against syphilis.

The intensity of treatment varies according to the stage of syphilis – for example patients with syphilis that’s affecting the brain (neurosyphilis) are treated with a different type of penicillin that’s administered intravenously.

There have been reports of the standard treatments for syphilis not working as well in people with HIV. Because of this some doctors are uncertain about the best way to treat the infection.

US guidelines say that HIV-positive patients with syphilis should receive the standard therapies but with more intensive follow-up.

But a team of researchers have found that this recommendation has a very poor evidence base.

They could only find 23 studies that provided an in-depth analysis of syphilis therapy for patients with HIV. Only two of these studies were ranked as high quality.

Reported treatment failure rates were as high as 22% for early syphilis, 31% for latent syphilis and 28% for neurosyphilis. These rates are much higher than the 3 to 10% seen in HIV-negative patients.

The researchers don’t rule out the possibility that standard syphilis therapy is less effective in patients with HIV. But they think it’s more likely that there are other reasons for the high failure rate in these studies, for example, reinfection with syphilis.

There’s more information on syphilis and its treatment in our HIV Treatments Directory, now available on our website here.
HIV & the criminal law
HIV & the criminal law is now available to buy. Launched as a web resource during the International AIDS Conference in Vienna, the print edition is now in stock.

It explores the full range of issues relating to the criminalisation of HIV exposure and transmission around the world, with information on current laws and practice internationally.

Produced in a handy A5 size, HIV & the criminal law is priced at £34.95, but can currently be bought at a special introductory price of £29.95.

A gap in the facts?
Women for Positive Action is an organisation that campaigns for better inclusion of women’s needs into HIV research and care.

Dr Sharon Walmsley, WFPA Faculty Member, recently wrote an article for us on the under-representation of HIV-positive women in clinical trials.

This feature first appeared in our regular publication HIV treatment update and is now available on our website.

HIV & hepatitis
A new, revised edition of NAM’s patient information booklet, HIV & hepatitis, is now available online and in print.

If you work in a clinic or support group in the UK, you can order printed copies of our booklets for free for your clients and patients through our free booklet scheme.

HIV & hepatitis is also available online in French, German, Italian, Portuguese, Russian and Spanish.

Facebook

Join our Facebook network – and ask your friends to join us too!

For more details, please contact NAM

tel: +44 (0)20 7840 0050
fax: +44 (0)20 7735 5351
email: info@nam.org.uk
web: www.aidsmap.com

SEPTEMBER 30TH 2010

HIV Weekly, 29 September 2010

HIV treatment and bone health
HIV treatment and resistance
HIV and women
HIV and lung disease
HIV treatment and bone health
New European research suggests that treatment with tenofovir (Viread, also in the combination pills Truvada and Atripla) results in more bone loss than therapy with abacavir (Ziagen, also in the combination pills Kivexa and Trizivir).

Increasing attention is being paid to bone density in patients with HIV.

The virus itself can cause loss of bone, but there’s now quite a lot of research showing that this can also be a side-effect of HIV treatme

SEPTEMBER 22ND 2010

HIV Weekly, 22 September 2010

Long-term adherence
Hepatitis C treatment for women with HIV and hepatitis C
Nevirapine switch possible at any CD4 cell count
HIV and the law
Long-term adherence
The longer a person taking HIV treatment keeps their viral load undetectable, the lower the risk of it rebounding, new research shows.

The Canadian study involved 1305 patients who were starting HIV treatment for the first time.

Treatment reduced viral load to undetectable levels in all the patients.

However, it subsequently rebounded in 21% of patients.

One of the factors associated with an increase in viral load was the amount of time that it had been suppressed to undetectable levels.

The risk of rebound was highest during the first year of treatment. But after that, the longer that viral load was suppressed to undetectable levels, the lower the risk of it increasing.

This was true at all levels of adherence.

Each month of viral suppression reduced the risk of rebound by about 8%.

This suggests that the consequences of missed doses may be less severe the longer a patient has been taking treatment.

Nevertheless, the researchers emphasise that people taking HIV treatment should aim to take all their doses correctly.

Even after taking into account the amount of time viral load was suppressed, those who took 95% or more of their doses were less likely to experience an increase in viral load than those with the poorest adherence.

There’s help available to you, to help you take your HIV treatment correctly. You can find out why adherence is so important in the NAM booklet on this subject. There are also tips to help you take your treatment, and information on where you can turn to for support.

Hepatitis C treatment for women with HIV and hepatitis C

Women with HIV and hepatitis C are more likely to experience side-effects that lead to stopping or changing hepatitis C treatment than co-infected men, report US investigators.

They reviewed the results of three big trials looking at the safety and effectiveness of hepatitis C treatment in people with HIV.

Women were much more likely to stop treatment because of side-effects than men (24 vs 16%). In addition, more women than men experienced side-effects that led to treatment being changed (61 vs 48%).

Taking HIV treatment that included a non-nucleoside reverse transcriptase inhibitor (NNRTI) was associated with women stopping treatment.

Efavirenz (Sustiva, also in the combination pill Atripla) is an NNRTI that can cause mood and sleep problems. Higher blood concentrations of this drug have been seen in women. The investigators suggest that this may explain why therapy with NNRTIs was associated with treatment discontinuations in women.

Visit our website for more information on hepatitis C.

Nevirapine switch possible at any CD4 cell count
People taking HIV treatment who have an undetectable viral load can safely switch treatment to nevirapine (Viramune) when their CD4 cell count is at any level.

This is the latest advice from European drug regulators.

Nevirapine is an NNRTI. Patients who have a higher CD4 cell count when they start treatment with the drug have a risk of developing serious liver problems or an allergic reaction.

Therefore, wo

HIV WEEKLY 16TH SEPTEMBER 2010

HIV Weekly, 16 September 2010
In this issue
HIV and swine flu
CD4 cell count and Kaposi’s sarcoma
HIV and kidney problems
HIV and swine flu
There was a lot of concern last year about swine flu (H1N1). People with serious underlying health conditions – including those caused by immune suppression – seemed to be more likely to develop complications when they contracted swine flu. Therefore people with HIV were recommended to be vaccinated against swine flu.

Now Spanish investigators have published a study showing that the consequences of swine flu were no more serious for people with HIV than for HIV-negative patients.

The researchers reviewed the medical records of 585 patients who were admitted to hospital because of swine flu. Twenty-six of these people were HIV-positive.

Most of the HIV-positive patients were taking HIV treatment. Their average CD4 cell count was over 500 and 84% had an undetectable viral load.

There were no differences in the types of swine flu symptoms between the HIV-positive and HIV-negative patients.

Both groups of individuals started to get better two-and-a-half days after they were admitted to hospital, and there was no difference in the length of their stay in hospital.

Similar rates of complications were seen in the two groups of patients. Three of the HIV-negative patients died, but all the HIV-positive patients made a full recovery.

The researchers describe these results as “remarkable”.

CD4 cell count and Kaposi’s sarcoma
Rates of the AIDS-defining cancer, Kaposi’s sarcoma, fell dramatically after the introduction of effective HIV treatment, US research has shown.

But the same study showed that the cancer is now being found more frequently at higher CD4 cell counts. The researchers think that is another reason why patients should start HIV treatment promptly.

Researchers from the US military looked at rates of Kaposi’s sarcoma in HIV-positive military personal between 1985 and 2008.

Compared to the period before 1990, those receiving care after 2002 had a 72% reduction in their risk of developing the cancer.

However, Kaposi’s sarcoma appeared to be occurring at higher CD4 cell counts. Before 1990, only 18% of patients had a CD4 cell count above 350 when the cancer developed. However, after 2002 this had increased to 35%.

Nevertheless, the researchers found that a higher CD4 cell count reduced the risk of the cancer.

In addition, patients with a CD4 cell count below 350 were about eight times more likely to develop Kaposi’s sarcoma than those with a CD4 cell count above this level.

The researchers found some evidence that, among patients with a CD4 cell count above 350, those taking HIV treatment were less likely to be diagnosed with the cancer.

HIV and kidney problems
Few HIV-positive patients in Europe have end-stage kidney disease, researchers have found.

Over 60,000 patients were included in the study, but just 122 patients had kidney disease that was so serious it required dialysis or a transplant.

Nearly all the patients were taking HIV treatment, 88% had a viral load below 500 copies/ml, and average CD4 cell count was around 350.

Most of the patients with serious kidney problems were men, and the majority were of black race.

HIV-related kidney disease was the biggest single cause of serious renal problems.

A total of 26 patients had had a kidney transplant. Eight of these had experienced organ rejection, but all the patients were still alive.
Meet Jackie

Find out more about the newest member of our team, Jackie, who has recently started working as NAM’s Communities Engagement Officer.

You can read about Jackie and her plans for the role in our blog.

Life check

How much do you know about living with HIV? Test your knowledge with our HIV life check.

Will Craig reach Vienna?
Our heroic cyclist, Craig, is due to arrive in Vienna today, at the end of his massive cycle ride from London (2200 miles!), raising funds for NAM – thanks to your generosity he reached his £1500 target and decided to raise the stakes to £2000!

You can sponsor Craig and read more about his incredible journey at www.justgiving.com/vienna.

Or if you would like to find out more about raising money for NAM, visit our fundraising webpages or contact us at info@nam.org.uk or 020 7840 0050.