News in brief

This article originally appeared in HIV Treatment Update, a newsletter published by NAM between 1992 and 2013.

Summaries of news from the last quarter. For full news reports and references to the original sources, visit www.aidsmap.com/news.

Smoking has more influence on life expectancy than HIV-related factors

Much of the increased mortality seen in people with HIV can be attributed to smoking, Danish investigators report. Their study involved 2921 adults receiving HIV care in Denmark between 1995 and 2010, who were matched with 10,642 HIV-negative controls, and then followed for four years on average. Among HIV-positive participants, 47% were current smokers, 18% were former smokers and 35% had never smoked. The corresponding rates for the controls were 21, 33 and 47%.

The risk of death by any cause was four times higher for current smokers compared to HIV-infected people who had never smoked, and the authors calculated that 35-year-old non-smokers had a life expectancy of 78 years. This compared to a life expectancy of 69 years for former smokers, and one of just 63 years for current smokers. The researchers calculated that the HIV-positive participants lost five years of life expectancy due to their HIV infection and that twelve years were lost because of smoking.

The authors believe their findings have important implications for HIV care, showing the importance of smoking cessation counselling and support.

Glossary

Cytomegalovirus (CMV)

A virus that can cause blindness in people with advanced HIV disease.

deoxyribonucleic acid (DNA)

The material in the nucleus of a cell where genetic information is stored.

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

Food and Drug Administration (FDA)

Regulatory agency that evaluates and approves medicines and medical devices for safety and efficacy in the United States. The FDA regulates over-the-counter and prescription drugs, including generic drugs. The European Medicines Agency performs a similar role in the European Union.

reservoir

The ‘HIV reservoir’ is a group of cells that are infected with HIV but have not produced new HIV (latent stage of infection) for many months or years. Latent HIV reservoirs are established during the earliest stage of HIV infection. Although antiretroviral therapy can reduce the level of HIV in the blood to an undetectable level, latent reservoirs of HIV continue to survive (a phenomenon called residual inflammation). Latently infected cells may be reawakened to begin actively reproducing HIV virions if antiretroviral therapy is stopped. 

For the full news report see: www.aidsmap.com/page/2561382

HPA urges further action on HIV testing

England’s Health Protection Agency (HPA), in its 2012 annual HIV report, drew particular attention to the need for improvement in HIV testing rates – six of its eight recommendations concern testing. In 2011, there were 3010 new diagnoses among gay men, the highest annual figure ever. HIV prevalence in the general population was 0.15%, but was considerably higher in the black African community (3.7%) and among men who have sex with men (4.7%). Among those diagnosed, 47% were diagnosed with a CD4 cell count below 350 cells/mm3.

Whereas people who attend sexual health clinics usually have an HIV test during their visit (70% of all attendees, 84% of gay and bisexual men) and coverage is extremely high at antenatal clinics (97%), an HPA audit done with 40 sexual health commissioners in high-prevalence areas found that only 31% had commissioned HIV testing at GP surgeries, and just 14% had commissioned it as part of general medical admissions to hospitals, despite recommendations by both BHIVA and NICE for HIV testing in these settings.

Commenting on the report, Deborah Jack of the National AIDS Trust (NAT) made a connection between the higher rates of late diagnosis in black African people and the poor provision of HIV testing in GP surgeries. “We know that African people are three times more likely to be diagnosed through their GP than a sexual health clinic,” she said, urging more commissioning of HIV testing in general practice.

Testing frequency needs to rise too: 63% of gay men newly diagnosed with HIV at a sexual health clinic had not attended that clinic for testing in the previous three years.

For the full news report see: www.aidsmap.com/page/2556387

Dual regimen cures most people with HCV genotypes 1, 2, or 3

A 12-week, once-daily oral regimen of Gilead’s hepatitis C (HCV) polymerase inhibitor sofosbuvir and Bristol-Myers Squibb’s NS5A inhibitor daclatasvir, without interferon or ribavirin, produced sustained virological response rates (SVRs – equivalent to cure) for most treatment-naive, HIV-negative people, and appeared effective regardless of HCV subtype.

Various combinations of sofosbuvir plus daclatasvir, with or without ribavirin, were tested in an open-label trial. SVR rates ranged from 88 to 100% in patients with genotypes 2 and 3, and 100% in those with the supposedly harder-to-treat genotype 1, with an overall SVR rate of 93%.

As promising as the sofosbuvir plus daclatasvir combination appears to date, its fate is uncertain. Earlier this year Gilead indicated that it would no longer pursue development of this particular regimen, sparking several online petitions, and is thought to be focusing on its own NS5A inhibitor GS-5885, allowing the company to produce coformulated combination pills. Once individual drugs are approved and marketed, however, clinicians will be able to mix and match them.

For the full news report see: www.aidsmap.com/page/2552256

Drug-resistant HIV falls in Western Europe

There has been a significant fall in the proportion of treatment-experienced HIV-positive people in Western Europe with resistance to antiretroviral (ARV) drugs.

A retrospective study looked at 20,323 people treated with ARVs between 1997 and 2008 in seven countries. Eighty per cent had, at any time point, at least one major resistance mutation to at least one ARV; two-thirds had resistance to a nucleoside (NRTI) drug, half to a non-nucleoside (NNRTI) and one-third to a protease inhibitor. However, there was “clear evidence” of a reduction in resistance to NRTIs and protease inhibitors after 2001. The proportion who had run out of treatment options peaked at about 30% in 2000, but with the introduction of new drugs and drug classes, this had fallen to below 1% in 2008.

The results stand in contrast to those of a recent Australian study that predicted life expectancy would be reduced due to the exhaustion of treatment options.

For the full news report see: www.aidsmap.com/page/2563857

CMV may contribute to amount of HIV hiding in cells

The presence of cytomegalovirus (CMV) in blood and semen is associated with higher levels of HIV DNA in blood. A US study involving 113 gay men recently infected with HIV found that 46% of the men tested positive for CMV, a common and usually asymptomatic virus of the herpes family.

The presence of CMV in immune-system cells and longer duration of HIV infection were both associated with higher levels of HIV in cellular DNA. CMV was not, however, associated with HIV viral load in blood or semen. This means that while CMV did not seem to influence the amount of infectious HIV viral particles in the blood, it was associated with more proviral DNA – the instructions to make HIV – integrated into the genetic code inside cells. The association between CMV infection and proviral DNA only became significant after participants had been infected with HIV for more than 120 days.

Many approaches to a cure for HIV depend on finding ways to reduce the amount of proviral HIV DNA hiding in long-lived reservoir cells, as this is the source for new virus when people come off treatment. The investigators conclude: “Future studies should determine if persistent CMV replication can be targeted as a strategy to reduce the size of the latent HIV reservoir.”

For the full news report see: www.aidsmap.com/page/2563497

New class of TB drug approved

Bedaquiline, a new TB drug, was licensed for treatment by the United States Food and Drug Administration (FDA) on 2 January. Patented by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, it is the first new TB drug since the licensing of rifampicin in 1966.

In a study of patients with drug-resistant (DR) TB, 48% on bedaquiline became sputum-negative for TB versus 9% of patients on placebo.

The US Treatment Action Group (TAG), along with other HIV and TB activists, support early appropriate access to bedaquiline for people with DR-TB. Mark Harrington, Executive Director of TAG, said: “Bedaquiline will provide a major incentive for new sponsors and companies to introduce more new drugs, classes, combinations, and regimens into the clinical pipeline.”

Nathan Geffen of the Treatment Action Campaign in South Africa called for the drug to be made available to patients with DR-TB before it is approved there. “This demand was made as far back as 2009,” he said, “yet little progress towards pre-approval access has been made in South Africa.” At least 13,000 cases of DR-TB are estimated to occur in South Africa each year, one of the highest burdens of DR-TB in the world. The World Health Organization convened an expert meeting on the use of bedaquiline on 29 January.

For the full news report see: www.aidsmap.com/page/2557073

Tenofovir impairs enzyme that stops cells ageing

Telomeres are lengths of ‘junk DNA’ that sit at the end of chromosomes and stop genes from being lost in the process of cell division, exactly as the tip of a shoe lace stops it fraying. Cells that have lost their telomeres usually die and there is a theory that telomere loss is the underlying cause of a lot of the ageing process. Telomerase is an enzyme that adds units to the telomeres and keeps them working.

Researchers have found that, in the test tube the nucleotide (NRTI) drug tenofovir strongly impairs telomerase. They also found that the duration of treatment with NRTI drugs as well as biological age was associated with reduced telomere length and less telomerase activity, though this was not pinned specifically to tenofovir.

The study has implications for the role of NRTI drugs in general in the accelerated ageing seen in some people with HIV, and also for the possibility of unexpected side-effects showing up after many years on treatment with tenofovir, currently the most widely used single HIV drug in richer countries. The researchers found that, while NRTI drugs in general inhibited telomerase in the test tube, only tenofovir did at the kind of levels seen in people who take HIV treatment.

For the full news report see: www.aidsmap.com/page/2567149

News picks from other sources

As well as writing our news reports, our team of editors regularly select news from other sources for the news pages of our website. Here is a small selection of recent examples. For more of these, visit www.aidsmap.com/news

Is London’s gay scene self-harming through sex and drug use?

David Stuart of gay men’s drug project Antidote discusses increases in the use of methamphetamine and mephedrone in London’s gay scene and an increased tendency to inject them.

For the full news report, visit the Pink News website: http://bit.ly/WuDwpy

Stanford lab creates HIV-resistant cells

Stanford scientists have developed a techique to genetically engineer certain immune cells and make them resistant to HIV.

For the full news report, visit the San Francisco Chronicle website: http://bit.ly/WpYEgs

Dr Mark Dybul: The big push to defeat AIDS, TB and malaria

Every era offers something special. I think the most special thing about our current time is the incredible opportunity that scientific advances have provided in the field of global health, giving us the ability to completely control highly dangerous infectious diseases such as AIDS, tuberculosis and malaria.

For the full news report, visit the Huffington Post website: http://huff.to/WcLRyL

Viracept: Non-renewal of the marketing authorisation in the European Union

Before the expiry of the last five-year period of validity, the marketing authorisation holder did not apply to renew the marketing authorisation. Consequently, the authorisation for Viracept expired on 23 January 2013.

For the full news report, visit the European Medicines Agency website: http://bit.ly/YU6u1w