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Anti-HIV treatment

Prescribing errors

There are now over 20 antiretroviral drugs available for the treatment of HIV infection. HIV is an unusually complex area of medicine, and doctors need to be highly qualified and have a lot of experience before they are allowed to prescribe anti-HIV drugs. If the wrong doses or combination of drugs are prescribed, then there is a risk that either treatment won’t work properly or that it will cause side-effects.

Although there are special guidelines to help ensure that antiretroviral treatment is used appropriately, it is also important that a doctor considers a patient’s individual characteristics.

A study reported on aidsmap.com last week showed, however, that this doesn’t always happen.

Doctors in the United States looked at electronic prescribing records for 600 patients, who were issued with 900 prescriptions for anti-HIV drugs over a two-year period. They found that 53 prescriptions (6% of the total) for NRTI drugs were incorrect.

People with kidney problems were particularly likely to be issued with incorrect prescriptions. The research showed that almost a third of prescriptions issued to people with kidney problems were wrong. Some NRTI drug doses need adjusting if a person’s kidneys aren’t working properly, and this explains why so many prescriptions issued to this group of patients were wrong.

The researchers also found that prescriptions for ddI (Videx) were often incorrect, as were those for combination NRTI medicines, such as Combivir  (AZT and 3TC), Kivexa  and 3TC), and Truvada(tenofovir and FTC). This is because the dose of each drug in these medicines is fixed and cannot be adjusted to suit individual patient characteristics.

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Anti-HIV treatment for children

Risk of overdose with Kaletra liquid

Anti-HIV treatment has meant a longer, healthier life for many HIV-positive children. But less is known about the safety and effectiveness of anti-HIV drugs in children than in adults. Furthermore, not all the licensed anti-HIV drugs are available for use in children, and when a drug is available, it is important that its dose is adjusted to take account of a child’s age, weight and height. If too low a dose if used, then resistance to anti-HIV drugs can develop, but if too much of a drug is prescribed then side-effects, which can be serious, can occur.

This was shown by a case last week. A baby died when it received an overdose of the liquid formulation of the protease inhibitor Kaletra. The 44 day-old infant was given 6.5ml of Kaletra oral solution, and died nine days later as a result.

Abbott, the makers of Kaletra, have written to doctors reminding them that the oral solution of Kaletra is highly concentrated, containing 80mg of lopinavir and 20mg of ritonavir per mililitre, not per bottle.

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HIV and hepatitis B

Liver disease is now one of the leading causes of illness and death in people with HIV. This is because many people with HIV are also infected with hepatitis B virus, or (but sometimes, and) hepatitis C virus. 

Some anti-HIV drugs - 3TC (lamivudine), FTC (emtricitabine), and tenofovir (Viread) – work against both HIV and hepatitis B. If a person with HIV and hepatitis B is taking anti-HIV treatment, then their combination of anti-HIV drugs should include drugs that work against both viruses.

But, it is important that drugs that are effective against HIV are not used for the treatment of hepatitis B in HIV/hepatitis-infected people if they are not taking HIV treatment. This could lead to HIV developing drug resistance.

Researchers have recently found that an anti-hepatitis B drug called entecavir (Baraclude) also has a mild anti-HIV effect. Because of this, its maker, the drug company Bristol Myers Squibb, and drug regulatory authorities in the US, have written to healthcare providers warning that it should not be used in people with both HIV/hepatitis B unless they are taking potent anti-HIV treatment, otherwise, drug-resistant HIV might develop.

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HPV vaccination

Human papilloma virus (HPV) can cause anal and genital warts. Some strains of HPV, particularly HPV-16 and HPV-18, are associated with anal and cervical cancer. Two vaccines, Gardasil and Cervarix have recently been developed that have been shown to provide very high levels of protection against these strains of HPV.

Trials have shown that these vaccines work best in girls and young women who haven’t yet had sex, or are very sexually inexperienced, and who haven’t been infected with HPV.

And a recently published study has shown that the use of Cervarix doesn’t help treat pre-existing HPV infection. The findings of the study underline that the existing HPV vaccines are protective, not therapeutic.

In the UK, it was recently recommended that Gardasil should be provided to girls aged between twelve and 13.

Trials are currently underway to see how effective and safe the HPV vaccines are in boys and men.

People with HIV were excluded from trials during the development of the vaccines, so it is currently unknown if they protect people with HIV against the main cancer-causing strains of HPV. People with HIV have elevated rates of anal and cervical cancer.

Some gay men and people with HIV are paying for HPV vaccination from private doctors. If you are considering this option, make sure that the doctor you choose tests you to see if you are already infected with HPV.

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New from NAM

NAM's online bookshop

Please visit NAM's brand new online bookshop at www.aidsmap.com/booksop 

You can now purchase all our publications online, including:

• AIDS Treatment Update
• Criminal HIV Transmission
• HIV & AIDS Services in the UK
• HIV & AIDS Services Worldwide
• HIV & AIDS Treatments Directory
• HIV Reference Manual
• HIv Treatment Training Manual
• Living with HIV
• Patient Information Booklets (15 titles)
• Preventing HIV

Alternatively, please contact us by phoning 020 78400050 or emailing info@nam.org.uk