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HIV & AIDS Treatment in Practice #30, July 2 2004: News
A regular electronic newsletter for health care workers and community-based organisations on HIV treatment in resource-limited settings. It is supported by and produced in collaboration with St Stephen's AIDS Trust and the International HIV/AIDS Alliance.

Its publication is also supported by Positive Action of GlaxoSmithKline, Boehringer Ingelheim and the Access 4 Trust.
   Last updated: 02.09.04
Highlighted news story



Multivitamins costing $15 per person per year significantly reduced the risk of HIV disease progression and death in HIV-positive pregnant women in Tanzania, according to a study published in the July 1st edition of the New England Journal of Medicine. The investigators conclude that multivitamins would be a cheap, simple, and effective means of delaying the need for antiretroviral therapy in HIV-positive pregnant women in resource limited settings.








Developments in antiretroviral access


A generic fixed-dose combination of nevirapine, lamivudine (3TC), and stavudine (d4T), which is widely used in antiretroviral treatment programmes in Africa, is effective and safe, according to a study published in the July 3rd edition of the Lancet. The investigators also established that drug concentrations within fixed doses tablets were within expected values. An editorial in the same edition of The Lancet says that the study leaves no doubt about the efficacy and safety of generic fixed-dose antiretrovirals.




Glaxo SmithKline this week announced that it has granted voluntary licenses for two of its antiretrovirals – AZT and 3TC – to the South African generic manufacturer Thembalami (a joint venture of the Indian company Ranbaxy and Adcock Ingram).




The World Health Organization has removed two generic antiretrovirals manufactured by the Indian company Cipla from its list of prequalified antiretrovirals following the detection of irregularities in paperwork produced by one Bombay contract laboratory carrying out bioequivalence tests on the products, it emerged today.




President Bush is due to announce today that Vietnam will become the fifteenth country to receive support from the President’s Emergency Plan for AIDS Relief (PEPFAR), and the sole Asian recipient of US funds.




Two countries in West Africa have announced substantial cuts in the cost of antiretroviral drugs this month. Cote d’Ivoire is to cut the cost of triple therapy to around $3.33 a month as a result of a US grant, whilst Gabon has cut the cost of treatment to $4 a month for the unemployed and $10 a month for civil servants as a result of a grant from the Global Fund to Fight AIDS, TB and Malaria.




Uganda this month became one of the first African countries to provide free antiretroviral treatment, using a loan from the World Bank to purchase $1.3 million- worth of antiretrovirals for 2700 patients unable to pay $30 a month for imported generic products. 15,000 Ugandans are already obtaining treatment by various means, chiefly through purchase of drugs.




The World Bank is to give $60 million to three African countries already beginning to implement antiretroviral treatment for HIV in the first major grant from its Regional HIV/AIDS Treatment Acceleration Project (TAP).




A Zimbabwean pharmaceutical company has begun manufacturing generic antiretroviral (ARV) drugs in a bid to significantly reduce the cost of the medication for people living with HIV/AIDS.





Drug toxicities and side effects


Anti-HIV therapy based on the non-nucleoside (NNRTI) nevirapine (Viramune) is associated with an increased incidence of serious liver toxicities in HIV-positive pregnant women with a CD4 cell count above 250 cells/mm3, according to a study published in the July 1st edition of the Journal of Acquired Immune Deficiency Syndromes.



Over a quarter of HIV-positive children and adolescents had body fat redistribution and over a third had elevated blood lipids according to a European study published in the July 2nd edition of AIDS. An AIDS diagnosis, female sex, and the use of a protease inhibitor or d4T were all independently associated with body fat redistribution and abnormal blood fats in the children and adolescents.




Use of antiretroviral therapy can lead to immune reconstitution hepatitis in HIV/HBV-coinfected patients even if they are taking lamivudine, according to a pair of case reports in the July 1st edition of Clinical Infectious Diseases




Drug resistance


Each year this distinguished workshop reports on the progress in basic science in HIV drug resistance including profiles of new agents, illuminating mechanisms of resistance and viral kinetics and considers the clinical relevance of these developments for those engaged with direct patient care.




The mapping of resistance pathways in non-B patients is becoming increasingly important for two main reasons.




Many guidelines now include recommendation for resistance testing before patients begin antiretroviral therapy where the prevalence of population resistance is known to be 10% or more.




A number of studies of the prevention of mother to child transmission (PMTCT) now appear to point to an ominous conclusion: single-dose nevirapine (NVP) may not be the prophylactic panacea for the developing world.




A Canadian study has found that treatment failure due to drug resistance did not significantly contribute to the mortality of people with HIV in British Columbia between 1997 and 2001. The study, published in the July 15th edition of The Journal of Infectious Diseases (now available online), is the first to suggest that the exhaustion of treatment options due to drug resistance may not cause as much loss of life from HIV/AIDS as previously thought, and that it is insufficient and/or intermittent therapy that is more likely to lead to death.




Infection with a drug-resistant strain of HIV slightly accelerates CD4 T-cell decreases in the first year after seroconversion, but causes no difference in CD4 cell counts thereafter, according to a research letter published in the July 2nd edition of AIDS.



Basic science
  • The male genital tract is not a sanctuary site for HIV, argue Dutch researchers

    A group of Dutch researchers have argued that the male genital tract is not an important site for the production of drug-resistant strains of HIV. They suggest that the HIV found in semen does not originate from cells in the semen (which contains low levels of antiretroviral drugs), but from the blood or the lining of the genital tract (which are exposed to therapeutic levels of the drugs). The article is presented in the July 2nd edition of AIDS.





    Other news headlines


    HIV-positive teenage girls are already infected with many of the human papillomavirus (HPV) subtypes that are considered high risk for cervical cancer, and the infection persists almost twice as long as in HIV-negative teenagers, according to the results of a US study published in the July 1st issue of The Journal of Infectious Diseases. This places the girls at a higher risk of developing cervical cancer in adulthood, and more frequent screening, as well as vaccine trials aimed at HPV prevention, should take place, argue the study's authors.




    Assuming that a regimen would be easier to adhere to just because it is once-daily could mean that other important factors affecting adherence are neglected, according to a study published in the July 1st edition of the Journal of Acquired Immune Deficiency Syndromes. Investigators found that multiple factors, including a high pill burden, side-effects and dietary restrictions, rather than just dosing frequency, impact on adherence. The study also found that of seven HAART regimens currently in use, the one which patients perceived as the easiest to adhere to was a twice-daily regimen consisting of two pills a day, without any dietary restrictions.




    A new prototype test for TB lacks sufficient sensitivity as a sole test for TB in a predominately HIV-infected population in Botswana, according to a study published in July 1st edition of Clinical Infectious Diseases. Five other commercially available serodiagnostic TB tests evaluated in this study were also found to be insufficiently sensitive as sole diagnostics




    A new diagnostic technique has been developed which allows for the diagnosis of HIV within less than one week of infection. The new tool makes possible the detection of HIV viral load as low as two copies/ml, considerably lower than the limit of detection available with the RNA PCR tests currently used to measure viral load. The development of these improved testing methods is reported in the July edition of the American Journal of Clinical Pathology, which is now available on-line.




    A new viral load test developed by the University of Maryland’s Institute of Human Virology could be employed in the remotest settings in Africa that can be reached by car, expanding access to viral load testing from central hospitals down to primary health care level.




    Levels of HIV RNA in rectal mucosa secretions from men who have sex with men (MSM) are higher than those in blood and semen, according to a study presented in the July 1st edition of The Journal of Infectious Diseases. The results suggest that unprotected insertive anal intercourse may involve exposure to higher levels of free virus than previously believed, even where the receptive partner's plasma viral load is undetectable on HAART.




    Up to half of infants infected with HIV in nine major studies of mother to child HIV transmission contracted the virus through breastfeeding, and the risk of infection did not fall throughout the breastfeeding period, according to a meta-analysis published in the June 15th edition of the Journal of Infectious Diseases.




    Initiation of a HAART combination consisting of stavudine (d4T), lamivudine (3TC), nevirapine and nelfinavir in HIV-1-infected infants before the age of three months leads to long-term viral suppression, according to a study presented in the June 10th edition of the New England Journal of Medicine.



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