Adherence to HIV treatment
A large medical conference in the United States has provided an opportunity for researchers to present their findings about new anti-HIV drugs and treatment regimens.
Adherence is a term often used to describe taking medicines as prescribed. You'll get the most benefit from your HIV treatment if you take the right doses at the right time. There’s some evidence that people find it easier to take treatment regimens with fewer pills, but it hasn’t been clear exactly what sort of dosing makes a difference to people’s adherence.
Participants in the study were either taking HIV treatment that involved one pill, once a day, or treatment that involved several pills. Researchers looked at their adherence rates, as well as at health outcomes such as achieving an undetectable viral load and going into hospital.
People who took a single tablet a day were more likely to achieve an undetectable viral load, and were less likely to need to go into hospital. If they did need hospital care, it was less frequent and they stayed in hospital for shorter periods than people on multiple-tablet HIV treatment.
Having taken into account other factors, the study found that people on single-tablet treatment were twice as likely to be 95% adherent (that is, to take 95% of their doses at the right time).
The researchers suggest that a single-pill regimen can have significant benefits both for people living with HIV and for healthcare workers – and for healthcare systems as they may be cheaper to prescribe and reduce other demands on healthcare services.
Thinking about talking to your doctor about the treatment you’re taking? Our online tool, Talking points, is designed to help you prepare for that conversation: www.aidsmap.com/talking-points
Find out more about adherence in our Adherence & resistance booklet, available in UK clinics and on our website at: www.aidsmap.com/booklets
Hepatitis C treatment for people with HIV
Many people living with HIV also have hepatitis C (often referred to as co-infection). Liver disease caused by the hepatitis C virus (HCV) is an important cause of serious illness and death in people with this co-infection.
HCV can be treated and cured. But treatment outcomes are poorer in people with co-infection, especially if they have the harder-to-treat HCV genotypes 1 or 4. Results of a study looking at treatment outcomes in people with both HIV and HCV (genotypes 2 and 3), compared to people who only had HCV, suggest that having HIV isn’t a cause of a poorer response to HCV treatment.
The participants with HIV/HCV co-infection were less likely to achieve a sustained virological response (SVR) to HCV treatment, which is considered a cure, than people who only had HCV. However, they were also more likely to have serious liver damage as a result of their HCV – liver fibrosis or cirrhosis – which was a factor linked to a poor treatment response.
Another factor affecting participants’ response to HCV treatment included reducing the dose of ribavirin, one of the drugs used to treat HCV. More people with HIV reduced their dose of ribavirin to help with side-effects, such as anaemia.
However, once the researchers had taken factors affecting treatment response into account, HIV infection itself didn’t appear to be an independent cause of poor treatment response.
Because of the higher rate of advanced liver fibrosis in people with HIV – a very important cause of not responding to HCV treatment – the researchers recommended that HIV-positive people with HCV genotypes 2 and 3 be treated for HCV early, before damage to the liver happens.
Interested in hepatitis and HIV? Visit our hepatitis C topics page for more resources, feature articles and news about hepatitis and HIV co-infection. We’re also working with ELPA, the European Liver Patients Association, on a hepatitis information website for patient advocates and professionals working in hepatitis in Europe – check it out at www.infohep.org
HPV, anal cancer and HIV
Infection with certain strains of the human papillomavirus (HPV) can lead to pre-cancerous and cancerous cell changes in the anus, cervix and other areas of the body. (Other strains of HPV can cause genital warts, but do not lead to cancers.)
Rates of pre-cancerous anal cell changes or abnormal new cell growth (dysplasia and neoplasia), and of anal cancer, are higher in people with HIV than other groups, particularly in gay men living with HIV. Women with HIV are at higher risk of anal cell changes than women who don’t have HIV.
In the UK, all women are screened regularly for HPV-related changes in the cervix, and women with HIV are recommended to have annual cervical screening. However, the case for routine anal screening has not been clear.
About two-thirds of gay men and a fifth of women who took part in Spanish studies were found to have cell or tissue abnormalities that could eventually lead to anal cancer. The researchers suggest that both gay men and women would benefit from regular screening for anal cell changes.
The study found that HPV type 39 was a key risk factor for pre-cancerous cell changes.
Vaccines have been developed that provide a very high degree of protection against infection with HPV types 16 and 18, which have been linked with an increased risk of anal and cervical cancer. These vaccines work best if administered before an individual become sexually active. Vaccination campaigns in the UK have prioritised school-age girls, but there is now pressure to extend vaccine programmes in the UK to include young gay men. New vaccines are in development that will protect against more types of HPV.
HIV and kidney disease
Kidney disease is a significant cause of illness and death in people with HIV.
An increased risk of kidney (renal) failure for people with HIV has been associated with a low CD4 cell count, a high viral load and treatment with some antiretroviral drugs – plus traditional risk factors for kidney disease, which include diabetes and a family history of the disease.
A Danish study looked at whether having HIV increased the risk of developing serious kidney disease. The research found that HIV infection was linked to a five-fold increased risk of kidney disease serious enough to require a form of renal replacement therapy, which might involve dialysis (treatment that replaces the kidneys’ function) or a kidney transplant.
Having had an AIDS diagnosis, having high blood pressure and having injected drugs were also risk factors for needing renal replacement therapy. Kidney function declines with age, and the study found an increased risk of serious kidney disease amongst older participants.
Some anti-HIV drugs have been linked to kidney problems. This study found no association between the drugs tenofovir (Viread, also in Atripla, Eviplera and Truvada) and atazanavir (Reyataz) and the development of kidney disease requiring dialysis.
The researchers suggest that their findings have implications for routine monitoring for people with HIV. In the UK, it is recommended that people with HIV have their kidney function measured when they are diagnosed, when they start treatment, and every year after that. People who show signs of developing kidney disease should be referred to a specialist.
Editors' picks from other sources
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The new approach to health and social care services in England includes new and increased opportunities for people living with HIV to influence decisions and shape services in their local areas. But the new system is complex and not yet well understood. A new resource from NAT shows people living with HIV how to navigate the new structures, to understand the services and support that they have a right to expect and have their voice heard.
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