HIV update - 2nd December 2015

How many people have HIV in the UK?

The latest statistics on HIV in the UK have been released. Last year 6151 people were newly diagnosed with HIV, including 3360 gay men.

There are now 103,700 people living with HIV in the country, including an estimated 18,100 who don’t know they have it. This can be broken down into risk groups.

A total of 44,980 gay men are living with HIV. Across the country, 4.8% of all gay men have HIV. In recent years, the numbers living with HIV have risen because people are no longer dying early and also because of continued HIV transmission.

Black African people are also disproportionately affected by HIV, with 20,120 women and 9845 heterosexual men living with HIV. It is estimated that 4.4% of black African women and 1.8% of black African men are living with HIV.

In terms of heterosexuals of other ethnicities, 12,560 women and 11,445 men are living with HIV. While one in five of all people living with HIV are neither gay men nor black Africans, the proportion of the general population who have HIV remains low (prevalence 0.07% for women and 0.05% for men).

In addition, 2162 people who inject drugs are living with HIV – 2.2% of this group have HIV.

The National AIDS Trust responded to the data by calling for HIV testing and prevention programmes to be scaled up, rather than having their budgets slashed.

Two-drug maintenance therapy

A month ago HIV Update reported on promising findings of studies trying to simplify HIV treatment and reduce the number of drugs required. Those studies all involved the drug dolutegravir (Tivicay – an integrase inhibitor) which may be more powerful than some other anti-HIV drugs.

Another study has reported its results. This involved people who were already taking a combination of anti-HIV drugs that included the protease inhibitor atazanavir (Reyataz), boosted with ritonavir, plus two other drugs from the nucleoside class. All participants had an undetectable viral load.

Half the participants simplified their treatment by dropping one of the nucleoside drugs. Their results were compared with people who stayed on their previous combination.

After one year the results are encouraging and surprising. Fewer people taking the simpler two-drug regimen have had a viral rebound (2%) than in the group taking three drugs (6%). They were also less likely to have side-effects or to change their treatment.

These results are preliminary – the study will continue for another year.

PrEP available in France but still delayed in the UK

France has become the first country outside the USA, and the first country with a publicly funded health system, to approve pre-exposure prophylaxis (PrEP) for people who need it. From January, the prevention method will be available, from specialist clinics, at no cost to people with a high risk of acquiring HIV.

The French Minister of Health, Marisol Touraine, said: “Given the level of efficacy of this approach, which has been recognised by all national and international scientific experts in the battle against HIV/AIDS, I take the financial responsibility for this treatment, which can contribute to complete our global strategy against HIV and AIDS, so it can be available without financial restriction.”

But in the UK it seems that a decision on PrEP availability is unlikely to be made before June 2016 – at the earliest. Grassroots demands for PrEP are emerging through web campaigns like Prepster and IWantPrEPNow. The slowness of NHS decision makers is preventing people who need it from accessing PrEP. Those people who are getting PrEP are either men who took part in the UK’s research study of PrEP, individuals rich enough to afford a private prescription, or people importing the pills from overseas.

Long term consequences of severe weight loss

Weight loss can be a serious issue for people with HIV, especially if they have a low CD4 cell count or are ill because of the virus. Weight loss was very common before effective HIV treatment became available but may still occur while people have undiagnosed HIV or before they begin taking HIV treatment.

A new study suggests that people who have suffered unwanted weight loss in the past are more vulnerable to frailty in later life. They may be more likely to break bones if they fall.

The study looked at men who had previously been diagnosed with HIV-associated wasting (for example, they had lost 10% of their body weight). This group were compared with HIV-positive men who had not had wasting and also with a group of HIV-negative men.

An average of four years later, their health and physical function was assessed. While those who had experienced wasting had put some weight back on, this was mostly fat (rather than lean body mass) and they were still around 9 kg (1.5 stone) lighter than the other men. Moreover they had less muscle strength and poorer physical quality of life.

The study shows the importance of treating the causes of unwanted weight loss if it occurs.

There’s more information on this topic in NAM’s factsheet Unintentional weight loss.

Hepatitis C genotypes

Treatment for hepatitis C depends on which genotype (or strain) of the virus you have. Different genotypes are more common in different parts of the world.

In the United States, around three quarters of people with hepatitis C have genotype 1. This was one of the hardest to treat with the older hepatitis C treatments that include interferon injections. Most of the new hepatitis C drugs that have been developed are particularly good at treating genotype 1.

But in the United Kingdom, as many people have genotype 3 as genotype 1. In people who have genotype 3, hepatitis C remains difficult to treat and is more likely to lead to complications than in people with other genotypes.

So it’s good news that a number of recent studies have identified effective treatment regimens for people who have genotype 3. Doctors have the most experience with a combination of daclatasvir (Daklinza) and sofosbuvir (Sovaldi). But other tablet-only options have been investigated too.

Some of these involve drugs which are effective against all genotypes of hepatitis C. As well as being important for people with genotype 3, these drugs could also be invaluable in parts of the world where different genotypes are more common. For example, genotype 5 is widespread in South Africa and genotype 6 in several Asian countries. They would also make it much simpler to provide hepatitis C treatment without expensive genotype tests or having to tailor treatments to each person’s strain of the virus.