Four-days-on, three-days-off HIV treatment
All HIV treatments which are taken as tablets are normally taken seven days a week – usually once a day, although a few need to be taken twice a day. But for several years now, doctors in France have been trying different dosing regimens, such as only taking the tablets four days a week, although not all experts agree this is a safe strategy.
A possible advantage of taking medication this way is that it may reduce any harmful effects of the medication, such as side effects and long-term impacts on the kidneys, bones and so on. The disadvantage may be that it slightly increases the risk of treatment failure.
Doctors at one of Paris’s largest HIV clinics say that now one in seven of their patients are taking their HIV medication this way. And a larger group are taking a combination of two antiretroviral drugs (rather than three) – which is another way to reduce the burden of medications.
So far, it seems that as many people on the intermittent drug regimen are as undetectable as people taking their medication seven days a week. And they haven’t needed to use hospital facilities more often, while the cost of medication was reduced by more than half.
A separate French study looked specifically at this four-days-a-week strategy for people taking a combination of two antiretroviral drugs. In this study, the majority of people were taking dolutegravir plus lamivudine (Dovato) and most of the other people were on dolutegravir plus rilpivirine (Juluca). Previous studies tested a four-days-a-week strategy in people taking a standard combination of three drugs.
They were randomly assigned either to take their medication four days a week or seven days a week. After one year, the difference in the rates of viral suppression between the dosing schedules was negligible. Of those assigned to intermittent dosing, 94.5% maintained an undetectable viral load compared to 96.3% of the participants who took their medication daily.
But there were eight cases of treatment failure in the intermittent group and none in the daily group. Four of those with treatment failure had resistance to their current treatment.
So while a four-days-a-week strategy might be possible with a combination of three antiretroviral drugs, it does not seem safe with a combination of two drugs. The study also suggests that two-drug combinations – especially Dovato – might be less forgiving of skipped and missed doses.
aidsmapLIVE: HIV and ageing
Tonight at 5pm, we are broadcasting an aidsmapLIVE on HIV and ageing. NAM aidsmap's Susan Cole will be talking to HIV activist and older LGBT people's group chair Maurice Greenham; Head of HIV Services at Africa Advocacy Foundation and GROWS Project Co-ordinator at Sophia Forum, Juddy Otti; Communications Officer at the British HIV Association, Jo Josh; Dr Giovanni Guaraldi from the University of Modena and Reggio Emilia; and Marc Thompson from The Love Tank.
Watch live, or catch up after, on Facebook and Twitter.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) occurs when a person has experienced a traumatic event and is unable to process the shock properly. Such events could include a serious injury, illness, or accident; being abused or sexually assaulted; multiple bereavements; being rejected because of stigma or prejudice; war, political violence or forced migration.
PTSD can cause flashbacks, nightmares, a powerful sense of dread, nervousness and an avoidance of reminders of the event. Memories of the event can also be affected and people often say they have difficulty concentrating as they are easily distracted by worries.
As very little research on this topic has been done among people with HIV in European countries, HIV clinicians in Amsterdam included questions about possible symptoms of PTSD in questionnaires that they asked their patients to complete.
They found that 13% had symptoms of PTSD. This is higher than in the general population (in global surveys, 4% of people who have experienced a traumatic event), and is comparable to figures for people with cancer (15%), people with chronic pain (10%) and military veterans (14%).
Younger people living with HIV were more likely to have symptoms than older people.
The researchers say that healthcare providers should consider including screening for post-traumatic stress disorder as a routine part of clinical care for all people with HIV. Even if clinicians are not trained in mental health, they can work with the person living with HIV to identify preferred follow-up actions, such as referral to peer support or professional mental health services.
Vacancies at NAM
We are currently recruiting new writers to join our Emerging Voices programme and for an HIV Information Editor.
Our Emerging Voices programme gives new writers opportunities to develop their skills in a professional and supportive environment. Successful candidates will have the opportunity to write, update and edit information and articles on aidsmap, including news, email bulletins and factsheets.
Applications close on Friday 10 November at 9am.
The HIV Information Editor will work with the Managing Editor to ensure NAM aidsmap’s HIV information resources remain up to date, accessible and accurate. The role will include developing, monitoring and updating aidsmap’s About HIV pages and printed materials, as well as providing information in other media formats and on other platforms, such as video and social media.
Applications close on Monday 13 November at 10am.
There are a number of reasons why you may need to – or want to – change your HIV treatment. All drug regimens come with different pros and cons and there may be more options now than when the drugs you are currently on were chosen.
Doctors at the Chelsea & Westminster Hospital in London say that each year, 18% of their patients change their HIV treatment. This is roughly double the rate seen a decade ago. This is probably because there are now more alternatives than before, including drugs which are safer and easier to take.
- 37% of drug switches were because of side effects and intolerance to the medication. The three medications which people most commonly switched from were efavirenz (most often because of problems with concentration, mood swings or sleep disturbance), abacavir (usually because of its impact on heart health) and dolutegravir (for the same reasons as efavirenz, or because of weight gain).
- 33% of switches were because of drug interactions – when taking drugs together risks altering the effectiveness or side effects of the medication. While today’s HIV medications generally have fewer problems with drug interactions than older HIV medications, an increasing number of people living with HIV need to take treatment for other health conditions, so drug interactions are often a concern.
- 17% of switches were in order to simplify an HIV treatment regimen, for example by changing from three drugs to two drugs.
- Only 3% of switches were because the treatment was not working – because it failed to suppress the virus to undetectable levels.
Tell us what you think of NAM aidsmap
Have you benefitted from NAM aidsmap’s work? We would love to hear from you! Feedback is crucial for us to demonstrate the difference we’re making to people living with HIV and healthcare professionals, so your experience would help us to continue growing our supporters and delivering our life-changing work.
COVID-19 and cardiovascular health
People with HIV who were diagnosed with COVID-19 are at higher risk of having a major cardiovascular event in the following year compared to other people with HIV, a Spanish study has found.
Among 1000 people with HIV who didn’t have COVID-19, there were 57 major cardiovascular events (heart attack, stroke, angina, heart failure etc) in a year. Among 1000 people with HIV who had had COVID-19, there were 70 major cardiovascular events in the year following COVID-19.
The increased risk was particularly seen in relation to thrombosis (disorders caused by blood clots), heart failure (failure of the heart to pump sufficient blood) and other heart disorders including aneurysms (where a blood vessel balloons and may suddenly rupture).
The researchers say that cardiovascular health should be a focus of care in people with HIV recovering from COVID-19. They say it’s also important that people with HIV are vaccinated against COVID-19 and keep up to date with booster doses as people with HIV already have an increased risk of heart disease.
Editors' picks from other sources
‘I stopped counting how many friends died’: life after the contaminated blood scandal | The Guardian
Robert James: As a victim of one of the NHS’s worst failures, I campaigned for years for an investigation into what led to so many people becoming infected with HIV and hepatitis C. Finally we got an inquiry – but did we get answers?
Some HIV activity persists even when one is undetectable. Is this something to worry about? | TheBody
Experts say no because diet, exercise, and medications called statins have the potential to offset whatever damage this may cause. But the research may shed light on how to better suppress HIV – or even cure it.
UK Government commits to equal fertility rights for people living with HIV | National AIDS Trust
The UK Government has committed to changing fertility laws that discriminate against people living with HIV. Minister Maria Caulfield MP announced in Parliament that the Government will introduce legislation to allow people living with HIV with undetectable viral load (meaning they cannot pass HIV on) to donate eggs and sperm.
Among people who took the same antiretroviral regimen for two years, one third stuck with that combination for more than 10 years in a 539-person French group. Women, older people, and those taking co-medications were more likely to fill the same antiretroviral prescription for more than a decade.
Poz Nights at gay bars were wonderful – and now outdated | HIVPlusMag.com
For over 10 years, patrons seeking a carefree, stigma-free zone would venture through a secret entrance on the second floor of Manhattan’s Ritz Bar & Lounge – crossing through the owner’s personal apartment – to access 'POZ Night'.