HIV treatment – changing from efavirenz to etravirine
Etravirine (Intelence) is a new drug in the NNRTI class of antiretrovirals. Research suggests that it can be taken once a day, and that it’s difficult for HIV to develop resistance to the drug.
The side-effects of etravirine are mild, and unlike the NNRTI efavirenz (Sustiva, also in the combination pill Atripla), it does not cause mood and sleep disturbances.
Their research involved 38 patients. All had been taking an efavirenz-based combination of anti-HIV drugs for at least three months and had an undetectable viral load.
At the time of entry to the study, 90% of patients reported problems such as unusual dreams, insomnia, depression or anxiety.
Three months after switching to etravirine, this fell to 60%.
Viral load remained undetectable in all the patients, and they had good increases in their CD4 cell counts.
In addition, levels of ‘bad’ cholesterol fell after treatment was switched.
HIV care – clinics in the UK
The average distance patients travelled to a clinic was 2.5km (just over 1.5 miles).
Nearly all HIV care in the UK is provided at specialist clinics. If you are entitled to NHS care then all the treatment and care provided by these clinics will be free.
HIV clinics are open access – this means that you can attend any clinic you like. You don’t have to be referred by a GP or other doctor; and you can choose which clinic you go to.
It’s very important that you go to the clinic for regular check-ups. Researchers wanted to see how far patients lived from a clinic, and if there were any factors associated with travelling longer distances to receive HIV care.
Overall, 81% of patients lived within 5km of a specialist HIV clinic, and only 7% lived more than 10km from their nearest HIV treatment centre.
However, only 9% of people used the clinic that was closest to where they lived.
Patients who had had HIV for longer were more likely to travel longer distances to their clinic. The researchers think that this is because they were aware of the choices available to them.
There was also some evidence that wealthier patients were travelling to use a clinic. Patients with less money may not have been able to afford to travel. If you have a low income or are on benefits, then you may be eligible for help with the costs of travelling to your clinic.
Patients with more complex medical needs were also travelling greater distances.
The NHS website provides more information on help with travel costs.
Mother-to-child transmission – efavirenz treatment during pregnancy
Efavirenz (Sustiva, also in the combination pill Atripla) is as safe as nevirapine (Viramune) during pregnancy, a new study suggests. There were no birth abnormalities, and rates of other complications were also similar for the two drugs.
This study adds to evidence showing the safety of efavirenz during pregnancy.
With the right treatment and care, it’s possible for an HIV-positive mother to have a healthy, HIV-negative baby.
There been a lot of research into the safety of HIV treatment during pregnancy.
It’s currently recommended that treatment with efavirenz should be avoided during pregnancy (especially during the first three months). This is because of birth abnormalities in animals exposed to the drug.
Efavirenz is a very popular drug and a lot of women are already on it when they become pregnant. Therefore researchers in the Ivory Coast wanted to get a better understanding of its safety.
They monitored 344 women who were taking either efavirenz or nevirapine when they became pregnant.
There was no evidence that taking efavirenz increased the risk of any complication.
However, women taking efavirenz were more likely to have a termination. The researchers think that this is because they or their doctors were concerned about the risk of birth abnormalities.
But the investigators stress that there were no abnormalities in the infants of women treated with efavirenz, even though they took the drug during the early stages of pregnancy. They believe that their results are "reassuring". The study findings are also consistent with findings from other studies which have looked at the infants of women who took efavirenz during the first three months of pregnancy.