HIV Weekly, 5th August
Posted by: admin | Posted on: August 10th, 2009 | 0 Comments
Raltegravir likely to be approved for people starting HIV treatment in Europe
The integrase inhibitor raltegravir (Isentress) has taken an important step towards approval for use by people starting HIV treatment in Europe.
A scientific committee that assesses the safety and effectiveness of medicines in Europe has recommended that it should be approved for people starting HIV treatment for the first time.
Raltegravir stops HIV integrating with immune system cells. It has already been approved in the US for people starting HIV treatment, but its use in Europe is currently restricted to people who’ve taken HIV treatment before.
A clinical trial has shown that the drug is as safe and effective as efavirenz (Sustiva, also in Atripla), the preferred main drug in an HIV treatment combination, when taken with Truvada (FTC and tenofovir).
DDI side-effect
Researchers have found that treatment with ddI (Videx) is the sole risk factor for a rare, but serious, liver side-effect called noncirrhotic portal hypertension. This can involve significant liver damage and internal bleeding.
Swiss researchers identified all cases of this condition amongst HIV-positive patients in the country between 2000 and 2007. There were only 15. They then compared the characteristics of people who developed the condition with those who didn’t. The only factor that was significantly associated with it was treatment with ddI.
They think that this is because the drug can cause mitochondrial toxicity – damage to the part of cells that carry energy.
Although ddI isn’t used very much the researchers recommend that “a high index of suspicion is needed in ddI-exposed patients with clinical signs of liver disease”.
Diabetes in people with HIV
Treatment with some anti-HIV drugs can cause side-effects that increase the risk of diabetes developing.
This means that the body can’t process sugars properly and it can mean that a person is more likely to develop cardiovascular disease and other serious health conditions.
American researchers have found that HIV-positive patients with diabetes are just as likely as HIV-negative people to benefit from treatment for the management of the condition.
Three-quarters of HIV-positive patients achieve the desired target for total cholesterol levels and 55% had optimum blood pressure. Comparable proportions of HIV-negative individuals also met these targets.
The researchers recommend a “multidisciplinary approach” to the care of HIV-positive patients with diabetes that includes not only HIV specialists, but also healthcare workers skilled in the management of diabetes.
The March edition of HIV Treatment Update included a feature article on HIV and diabetes. This edition is available to download from aidsmap.com.
Hepatitis C co-infection and increased risk of illnesses
Many people with HIV are also infected with hepatitis C virus. This is called co-infection. Hepatitis C virus can cause serious liver damage, and liver disease is now an important cause of illness and death in co-infected people.
Now researchers have found that co-infection with hepatitis C also increases the risk of developing a number of AIDS-defining illnesses as well.
They recommend that doctors should take this into consideration when decisions are being made about the best time for a co-infected person to start HIV treatment.
British HIV treatment guidelines recommend that HIV treatment should be started when a person’s CD4 cell count is around 350. People with HIV and hepatitis C co-infection are especially encouraged to start taking anti-HIV drugs at this time.
NAM produces an information booklet called HIV & Hepatitis, which is available free to people living with HIV in the UK and is also distributed free through clinics and support groups in the UK. It can also be downloaded as a pdf .
Gay men and sexually transmitted hepatitis C
Many HIV-positive gay men in Amsterdam are co-infected with hepatitis C virus, and the virus is spreading rapidly amongst this population, according to new research.
In 2007 and 2008, gay men attending the city’s sexual health clinic were tested for the virus. A total of 18% of HIV-positive men were found to be co-infected, compared to just 0.4% of HIV-negative gay men.
The prevalence of hepatitis C amongst gay men who were HIV-positive increased from 14% at the beginning of the study to 20% at its end.
Rough sex and use of the recreational drug GHB were associated with an increased risk of infection with hepatitis C.
The April edition of HIV Treatment Update included a feature article on HIV and hepatitis C in gay men. This edition is now available to download from aidsmap.com.
