HIV Weekly - 20th October 2010

HIV treatment – no benefit from adding drugs to already successful therapy

New research has shown that there’s no benefit from adding extra anti-HIV drugs to a combination that is already suppressing viral load to undetectable levels.

The aim of HIV treatment for nearly all patients is an undetectable viral load in the blood.

Most of the tests used in clinics can measure viral load levels down to 50 copies/ml.

But even when viral load can’t be detected by standard tests, it’s possible that there are still low levels of HIV in the blood. In addition, the virus may be continuing to reproduce in other parts of the body, such as genital fluids or the fluid around and inside the brain and spinal cord (cerebrospinal fluids).

There’s concern that even very low levels of HIV replication may be damaging. For example, this may cause inflammation, increasing the long-term risk of some serious illnesses.

Doctors wanted to see if adding drugs to already successful combinations further lowered viral load in both cerebrospinal fluids and blood, and reduced evidence of inflammation in the brain.

Their small study involved ten patients. All were taking HIV treatment and they had had an undetectable viral load in their blood for an average of 6.5 years.

The study lasted eight weeks. At the time the patients entered the study their average blood viral load was 5 copies/ml, and the average viral load in cerebrospinal fluid was 2 copies/ml. Most of the patients had evidence of inflammation in the brain.

Treatment was intensified with a variety of drugs. But there was no evidence that it conferred any additional benefits.

HIV and sexual health – HIV treatment and genital HPV infection

Starting HIV treatment doesn’t reduce the prevalence or incidence of cervical infection with human papillomavirus (HPV), a study conducted in adolescents with HIV in the US has shown.

Certain strains of HPV can cause cervical cell changes that can lead to cancer. Rates of cervical cancer and anal cancer have increased in patients with HIV in recent years.

HIV treatment boosts the immune system, and US researchers wanted to see if this helped the body clear cervical HPV infection.

At the time the patients entered the study 70% had cervical HPV infection. During the study 70% of those without HPV at baseline contracted the virus.

Starting HIV treatment produced good increases in CD4 cell counts.

But this didn’t reduce the proportion of patients who had cervical HPV infection. Nor did it help prevent new infections.

The researchers believe their findings mean that the prevention of HPV infections is very important.

There’s now a vaccine that provides a very high level of protection against the strains of HPV that are most associated with cervical cancer.

It doesn’t help clear existing infections. Currently it’s only recommended for adolescent girls. Studies are underway to see if it has benefits for adult patients with HIV.  

All HIV-positive women are advised to have annual cervical screening (smear tests), and some researchers think that HIV-positive gay men should have tests to see if they have anal cell changes.

HIV services – UK HIV ‘quangos’ reformed

George Osborne, the UK’s Chancellor of the Exchequer, is expected to announce deep cuts in public spending today.

The Conservative/Liberal Democrat coalition has pledged to protect health spending.

But the restructuring of a number of so-called ‘quangos’ whose work involves HIV has already been announced.

Quangos are semi-autonomous non-governmental organisations.

The Health Protection Agency, which monitors rates of disease and epidemics, including HIV and sexually transmitted infections, will be abolished. Its work will be transferred to a Public Health Service within the Department of Health.

The Expert Advisory Group on AIDS, a group that mainly consists of doctors, will also be scrapped. However, it will be replaced with a new committee of experts.

The Independent Advisory Group on Sexual Health & HIV, whose membership is largely made up of voluntary sector representatives, is to be completely abolished. Its responsibilities will be taken over by a stakeholder advisory group.

The Advisory Group on Hepatitis and the Advisory Committee on the Safety of Blood, Tissues and Organs (currently considering the blood donation ban for gay men) will also be reconstituted as expert committees. The Independent Advisory Group on Teenage Pregnancy will be abolished.

Major changes to the benefits system have already been announced, including the reassessment of claims for Incapacity Benefit.