HIV update - 12th October 2016

No cure yet

Last week, the world’s media was full of headlines about an HIV cure being around the corner. News outlets rewrote and rehashed a misleading article from The Sunday Times, although more accurate analyses of the situation were rapidly published by NAM, the BBC and the researchers themselves.

The media have suggested that British scientists are close to finding a cure for HIV. They said that all traces of HIV had disappeared from the body of a London man who is taking part in a cure study.

It is true that the man has taken an experimental and intensive form of treatment which is designed to flush out HIV from ‘reservoirs’ in the body which conventional HIV treatment cannot reach. However, he has also taken normal antiretroviral drugs. When journalists said that his HIV had disappeared, they actually meant that his viral load in blood was undetectable – as is the case for most people taking conventional HIV treatment.

The study is at a very early stage. The researchers will not be able to describe participants as “cured” unless they stop taking antiretroviral treatment and are followed-up for several years. You can find out more about the study in this report from NAM and in a video produced by the researchers.

It is very premature to report a cure breakthrough.

Contaminated anti-HIV drug did not cause health problems

Nine years ago, the company producing an anti-HIV drug called nelfinavir (Viracept) identified a contamination at their factory and withdrew the drug from distribution. There was a lot of media coverage of the story at the time, especially as there was concern that the contamination could have raised the risk of cancer.

People who were taking nelfinavir at the time were provided with alternative anti-HIV drugs. The drug is no longer produced.

In the years since, several studies have provided reassurance. Animal studies showed that the levels of the toxic compound (ethyl methyl sulfone) in the contaminated batches would not cause cancers. Follow-up of patients confirmed this.

Those findings applied both to adults and children who took the drug. But as the drug was often provided to pregnant women, there remained some concern about the potential impact on unborn babies.

Now nine-year follow-up of children who were exposed to the drug in the womb has shown that they have not had health problems as a result. Rates of birth abnormalities and of cancers are at the same low rate as in children whose mothers did not take the drug.

Less than 100% adherence may cause problems – even if viral load remains undetectable

Lots of people living with HIV want to know whether an occasional late or missed dose of their anti-HIV drugs will matter. The answer to this is usually based on viral load remaining undetectable. We know that people who take all of the doses of their drugs in the right way usually maintain an undetectable viral load.

In recent years, the advice given by doctors and by organisations like NAM has relaxed a little. As the drugs have improved, we’ve seen that an occasional missed or late dose is not the end of the world. For example, last year we reported a study showing that – for some but not all anti-HIV drugs – around 85% adherence might be enough to keep viral load undetectable.

But now some researchers say that we may need to think about more than undetectable viral load. Ongoing activation of the immune system (chronic inflammation) is an unhelpful response of the body to having HIV. Many scientists believe it contributes to health problems in people living with HIV, including heart disease, kidney disease, cognitive decline and cancers. Inflammation can continue even when HIV is well controlled, with an undetectable viral load.

The researchers looked at levels of adherence and 24 different biomarkers of inflammation in a group of American men. Although all the men had an undetectable viral load, around one in eight sometimes missed doses of their drugs or took them late.

They found some evidence to show that men with less than 100% adherence had greater levels of inflammation. This might raise the risk of long-term health problems.

These findings need to be confirmed in other studies. 

New HIV diagnoses may be going down in the UK

There’s no sign of a decisive downturn in the number of gay men diagnosed with HIV in the UK, but the latest statistics are notable for suggesting a relatively stable situation. In every other year since 2000, the number of new diagnoses in gay men went up. In 2015, they may have gone down (slightly).

In 2015, a total of 3320 gay men were diagnosed with HIV. This is 40 fewer cases than in 2014 but is still double the number recorded in the year 2000.

A total of 2360 heterosexual men and women were diagnosed with HIV last year. There has been a long-term decline in new heterosexual diagnoses over the past decade because of changing migration patterns, with fewer people born in African countries coming to the UK.

The only group in which HIV diagnoses increased last year was people who inject drugs, due to a localised outbreak in Glasgow. Across the UK, 210 people who inject drugs were diagnosed with HIV.

Late diagnosis, with a CD4 count below 350, is lower than in previous years but is still a major problem – affecting four in ten of all newly diagnosed people. The problem is worse for heterosexual men and for people living outside London.

Almost all people who attend HIV clinics (96%) are taking treatment and almost all of them (94%) have an undetectable viral load.


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Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap