Treatment as prevention success in Denmark
A new study from Denmark provides some of the clearest evidence yet that ‘treatment as prevention’ can really make a big difference at the population level. There’s already very good evidence that individuals living with HIV can avoid transmitting the virus by taking HIV treatment.
But there are questions about whether HIV treatment can really stop HIV transmission across a population. For example, in the United Kingdom, too many people have HIV without realising it, so HIV continues to be spread, even though most people with diagnosed HIV are receiving HIV treatment.
But in Denmark, people get tested for HIV more often and so individuals tend to be diagnosed quite quickly, with a high CD4 count. Denmark has an efficient system of universal, free healthcare and the uptake of HIV treatment is very high.
The researchers estimate that the rate of new HIV infections in gay men (the main group affected by HIV in the country) is 0.14% per year. In other words, one in 700 gay men acquire HIV each year.
In contrast, incidence in gay men in the UK is four times higher at around 0.6% per year.
The study shows that treatment as prevention can work but that very high rates of early diagnosis, treatment uptake and viral suppression are required.
High blood pressure
Dutch researchers have found that high blood pressure (hypertension) is extremely common in middle-aged and older people living with HIV. People who were overweight, who smoked or who drank alcohol were more likely to have high blood pressure. But the study also showed that people who had previously used the old anti-HIV drug stavudine (d4T, Zerit) had more problems with high blood pressure.
The researchers recruited just over 500 people living with HIV over the age of 45, comparing them with a closely matched group of HIV-negative people. Reflecting the HIV epidemic in the Netherlands, the vast majority of participants were gay men.
While 36% of the HIV-negative participants had high blood pressure, this rose to 48% of HIV-positive participants. Even after making statistical adjustment for age, gender, smoking, alcohol, exercise and weight, people living with HIV were more likely to have high blood pressure.
The researchers found that part of the explanation for increased rates of high blood pressure in this group of older HIV-positive people were changes in body composition associated with lipodystrophy, including excess stomach fat and loss of fat. While the people in this study were mostly doing well on modern anti-HIV drugs, many had been taking HIV treatment for decades. Over a third had previously taken stavudine (d4T, Zerit), a drug that we now know is associated with lipodystrophy. These individuals were more likely to have high blood pressure.
There’s more information in NAM’s factsheet on high blood pressure.
Hepatitis C treatment
Does having HIV affect people's response to hepatitis C treatment?
We know that, without treatment, people who have HIV co-infection tend to have more liver damage and get sicker more quickly than people who have hepatitis C only. And people with HIV co-infection do not always have such good results with the older hepatitis C treatments (pegylated interferon injections + ribavirin tablets).
Concerning the newer hepatitis C drugs, results from clinical trials have shown identical results for people with HIV co-infection.
Now, two different studies of the "real-world effectiveness" of these drugs have produced conflicting findings. In both, the results for several hundred people with HIV/hepatitis C co-infection were compared with those of people with hepatitis C mono-infection only. In both, most people had genotype 1 and around half had cirrhosis.
An American study found that around 90% of people with co-infection had a sustained virological response 12 weeks after finishing treatment – identical results to people who had mono-infection.
But a Spanish study found slightly poorer results for people with co-infection, with around 5% or 10% fewer people achieving a sustained virological response. This could be because those with HIV were sicker when beginning the treatment, because some did not adhere to treatment as well, or because of damage to the immune system in people with HIV.
The conflicting results of the two studies show that the relationship between HIV and hepatitis C is still not fully understood.
There’s more information in NAM’s booklet 'HIV & hepatitis’.
Editors' picks from other sources
from The Huffington Post
There is a pill that can prevent HIV. I'm not referring to something that could potentially change the lives of future generations, one day, after decades of further research. This 'miracle drug' is real, it's ready now, and it is called pre-exposure prophylaxis, or PrEP.
Are gay men, as some would have it, ‘the biggest suicide cult in history’ or are we just having a good time? It’s well known that we have sex with more people than our heterosexual brothers. We’re also more likely to take drugs and drink to excess – and are much more likely to prance around in nightclubs with our tits to the wind. Is this indicative of great pain or of joy?
from National Institute of Allergy and Infectious Diseases
The US National Institute of Allergy and Infectious Diseases (NIAID) and its partners have decided to advance an experimental HIV vaccine regimen into a large clinical trial, the first for seven years. This new study, called HVTN 702, is designed to determine whether the vaccine is safe, tolerable and effective at preventing HIV infection among South African adults. The trial will begin in November 2016, pending regulatory approval. It will recruit 5400 HIV-uninfected men and women aged 18 to 35 years who are at risk for HIV infection.
The Hepatitis C Trust is considering seeking a judicial review of NHS England’s decision to ration access to hepatitis C treatment
from Hepatitis C Trust
The Hepatitis C Trust wrote to NHS England to ask it to reconsider its decision to limit the number of people with hepatitis C who are allowed access to new NICE approved drugs that cure the disease. On Monday 16th May, 2016 NHS England replied with a response that The Hepatitis C Trust did not find satisfactory. With great regret it now has to consider seeking a judicial review of the decision.