HIV treatment
Before approval, every anti-HIV drug goes through a series of clinical trials to make sure that it’s safe and effective.
Clinical trials have shown that the HIV treatment combinations used today have a very powerful anti-HIV effect.
American researchers found that equal proportions of patients starting treatment as part of a trial and during everyday care had an undetectable viral load after a year.
Gains in CD4 cell count were also similar.
But many people receiving routine HIV care failed to attend clinic appointments. The researchers think that social problems and difficulty accessing health care may have contributed to this.
It’s very important that you go to your HIV clinic for regular check-ups. If you are entitled to free NHS care, then all the treatment and care you receive from the clinic will be free.
You can also choose which clinic you go to. For help finding an HIV clinic in the UK, you can contact the Terrence Higgins Trust helpline, THT Direct, on 0845 12 21 200. You can also look for clinics near you by visiting the organisations section of our website, aidsmap.com.
New ritonavir tablet approved
All the protease inhibitors recommended for use in HIV treatment have their anti-HIV effect boosted by a small dose of a second protease inhibitor called ritonavir (Norvir).
A new formulation of ritonavir has been approved for use in Europe. Unlike the older formulation of this drug, these 100mg pills don’t need to be kept in the fridge.
This heat-stable formulation is already used in the combination pill Kaletra (lopinavir/ritonavir).
The approval of the new formulation of ritonavir in Europe is an important step in making it available in other regions of the world, where a heat-stable version of the drug is especially needed.
3TC and FTC not as equal as previously thought
Most people starting HIV treatment do so with a combination that includes either 3TC (lamivudine, Epivir) or FTC (emtricitabine, Emtriva).
This drug is normally taken in a combination pill. In the case of 3TC, this is called Kivexa , and the drug is combined with abacavir.
FTC is available combined with tenofovir in a pill called Truvada .
It is also in a pill called Atripla where it is combined with tenofovir and efavirenz (Sustiva). This drug provides triple-drug HIV treatment in one pill, taken once a day.
But some people take a combination that includes 3TC and tenofovir. This combination isn’t very widely used because it involves taking two separate pills.
All the people in the study were taking triple-drug HIV treatment and had had an undetectable viral load for at least six months. But their viral load then increased.
Tests showed that people taking 3TC and tenofovir were more likely to develop resistance, which meant that 3TC (and probably FTC) would no longer work well against their HIV.
The researchers also found that it could lead to resistance to an important new drug in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class called etravirine ( Intelence ).
The researchers believe that their findings have implications for HIV care. They warn, “budget restrictions and the perception of a fundamental equivalence between 3TC and FTC may…lead to this possibly suboptimal prescription.”
Mother-to-child HIV transmission
HIV treatment during pregnancy, an appropriately managed delivery, and not breastfeeding can reduce the risk of mother-to-child HIV transmission to very low levels.
Thanks to these interventions, the rate of mother-to-child transmission in the UK and similar countries is very low – about 1%.
However, a very small number of transmissions do still occur when the mother has a low viral load – under 500 copies/ml.
French researchers have found some reasons why this might happen.
Their study involved women who took HIV treatment during pregnancy and had a low viral load (below 500) at the time of delivery. Nineteen of these women passed on HIV to their infants and 60 did not.
The researchers found that women who transmitted HIV to their infants had higher viral loads throughout pregnancy than the women who did not pass on HIV.
None of the women who transmitted HIV had a viral load below 500 for the entire duration of their pregnancy. However, 40% of women whose infants were HIV-negative had a viral load below this level throughout their pregnancy.
During the 30th week of pregnancy, 42% of mothers who passed on HIV to their infants had a viral load above 10,000 compared to only 11% of those who did not.
In addition, women who transmitted HIV were more likely to report adherence problems during pregnancy than those who did not.
To further reduce the risk of mother-to-child transmission, the researchers emphasise the importance of controlling viral load throughout pregnancy and of good adherence to HIV treatment.
Treatment for lipodystrophy looks safe and effective
Some older anti-HIV drugs cause a collection of side-effects called lipodystrophy.
Often this involves the accumulation of hard, visceral fat around the abdomen.
Not only can this be distressing, but the accumulation of visceral fat has been associated with an increased risk of cardiovascular disease. Increased levels of such diseases have been seen in people with HIV.
The study was a placebo-controlled trial.
Overall, visceral fat levels fell by 17.5% in people taking tesamorelin compared to only 1% in people taking the placebo.
Body shape also improved in people taking tesamorelin.
In addition, cholesterol levels fell in patients treated with tesamorelin.
The drug is awaiting formal approval in the US, and its trade name will be Egrifta.