HIV treatment – when to start treatment
There’s a lot of debate about the best time to start taking HIV treatment.
In the UK, it’s currently recommended that everybody who is ill because of HIV should take anti-HIV drugs. Treatment is also recommended for people who have a CD4 cell count of around 350.
But some doctors think there would be additional benefits if treatment was started at higher CD4 cell counts.
Now an international study involving over 1200 people has shown that there are advantages to starting treatment soon after infection. The research also allayed some concerns about the possible risks of early treatment.
The researchers monitored their patients’ viral load. They wanted to see how many people experienced ‘treatment failure’ (defined as two viral load results over 400 copies/ml while on treatment) and how many patients developed drug-resistant HIV.
After eight years, 18% of patients had experienced treatment failure, and 6% had drug-resistant virus. This rate of failure was lower than the rate observed in a comparison group of people who started treatment according to current guidelines.
Older patients were less likely to develop resistance – possibly because they were more likely to take their treatment properly.
Starting treatment with a higher CD4 cell count was also associated with a reduced risk of treatment failure.
Each increase of 100 in CD4 cell count reduced the risk of treatment failure by 8% and the risk of resistance by 26%.
The researchers concluded that starting treatment early did not lead to high levels of resistance.
HIV treatment – darunavir monotherapy
It is recommended that HIV should be treated with a combination of at least three different anti-HIV drugs.
This means that treatment has a very powerful effect against the virus, and that there’s a low risk of drug resistance developing.
However, newer ritonavir-boosted protease inhibitors are very effective against HIV, and studies are underway to see if these drugs can be used as HIV treatment by themselves (known as ‘monotherapy’).
In the summer, results from one study showed that, after two years, 75% of patients taking ritonavir-boosted darunavir (Prezista) monotherapy had an undetectable viral load, compared to 81% of those taking traditional three-drug treatment.
They used an ultra-sensitive test, and found that after two years 17% of people taking monotherapy had a viral load between 5 and 50 copies/ml compared to 15% of patients who were taking triple therapy.
Hepatitis C – infections continuing to increase amongst HIV-positive gay men
HIV-positive gay men are still contracting hepatitis C virus, research from Hamburg shows.
There have been outbreaks of sexually transmitted hepatitis C among HIV-positive gay men in a number of European cities.
Liver disease caused by hepatitis C is a major cause of illness and death in HIV-positive patients who are co-infected with the virus
Unprotected sex, fisting, group sex, and drug use have been identified as risk factors for sexual transmission of the virus in gay men with HIV.
Researchers in Hamburg monitored approximately 5000 gay men between 2002 and 2010 to see how many became infected with hepatitis C.
A total of 99 were diagnosed with hepatitis C, and 88 of these were newly infected with the virus. Nearly all these men were HIV-positive.
In the first half of 2010, nine men were newly diagnosed with hepatitis C.
The researchers also found that a quarter of men who cleared the virus with treatment were re-infected with hepatitis C.
Issue 197 of our regular publication, HIV treatment update, included the feature Staying free of hepatitis C, which is now available online. For more information on HIV and hepatitis C co-infection, download our booklet HIV & hepatitis.
TB – still a major health issue for people with HIV
Tuberculosis (TB) is the single biggest cause of serious illness and death in people with HIV worldwide.
Even in resource-rich countries like the UK, TB is one of the most common AIDS-defining illnesses.
New research has shown that every day 4000 people with HIV die because of TB worldwide.
Most of these deaths are in sub-Saharan Africa.
Only about a third of patients with HIV/TB are receiving HIV treatment, and few people are receiving TB preventive treatment.
For more information on TB, visit our Tuberculosis & HIV webpages or download our patient information booklet.
Our booklets are also available free in clinics and organisations in the UK - if you work in a clinic or community organisation and would like to find out more about our 'free booklet scheme', contact us on 020 7837 6988 or info@nam.org.uk.