Anti-HIV treatment – new drugs
Anti-HIV drugs – resistance
HIV can become resistant to the drug used to treat it. You can minimise the risk of this happening by making sure that you take your anti-HIV drugs properly.
But resistance to some drugs can also develop when anti-HIV treatment is stopped, even under medical supervision.
This is because some drugs linger in the body. There’s not enough of the drug present to suppress HIV and this allows resistance to develop. The risk of this happening is particularly high with NNRTI drugs (nevirapine/Viramune and efavirenz/Sustiva ).
Anti-HIV drugs – nelfinavir
In June the protease inhibitor nelfinavir (Viracept) was withdrawn from the market after it was found that some batches had been contaminated with excess amounts of a potentially cancer-causing substance used in the drug’s manufacture.
Nelfinavir’s European license was temporarily suspended because of this contamination. But European drug regulatory authorities are now satisfied that nelfinavir’s makers, Roche, have taken steps to make sure the contamination never happens again and are recommending that the drug’s license is returned.
Very few people were taking nelfinavir in the UK when the drug was recalled. But the drug does have important “niche” uses, including use for post-exposure prophylaxis and during pregnancy. But US drug regulatory authorities recently recommended that pregnant women should not take nelfinavir because a substance linked to cancer is used in its manufacture. The advice was issued even though the excess contamination did not affect the US. It is therefore doubtful that nelfinavir will again be used during pregnancy in Europe.
Side-effects
Illness
The amount of HIV-related illness and death has fallen dramatically in the UK and similar countries since effective anti-HIV treatment became available.
But people with HIV can still become unwell, and doctors have seen some important changes in the causes of illness and death in people with HIV in recent years.
For example, the AIDS-defining cancers Kaposi’s sarcoma and non-Hodgkin’s lymphoma are now very rarely seen. But researchers have noticed that people with HIV are more likely than the general population to develop some non-AIDS-defining cancers. The latest research from America shows that people with HIV are more likely to develop anal cancer, Hodgkin’s lymphoma, liver cancer and lung cancer. It is thought that this is because some of these cancers – for example anal cancer, liver cancer and lymphoma – are linked to other infections, and also because the long-term effects of immune suppression caused by HIV leave the body more vulnerable to cancer.
However, even if the rates of some cancers were elevated, its important to remember that they were still rare.
Researchers have also found that some bacterial infections, heart and lung disease, depression and nerve problems occur more often in people with HIV. They found that older people, and those with a low CD4 cell count and high viral load were most at risk.
Some doctors think that the risk of non-AIDS related illness at lower CD4 cell counts is a powerful argument for starting HIV treatment when a person’s CD4 cell count is 350. At the moment, treatment guidelines say that treatment should be started when a person has a CD4 cell count between 200 – 250.
Hepatitis C
There are a number of reasons why sexual transmission of hepatitis C may be more likely in HIV-positive gay men. It has been shown that hepatitis C viral load is higher in the semen of HIV-positive men. There’s also good evidence that sexual practices, like fisting and group sex, combined with drug use also have a high risk of hepatitis C transmission because they might involve damage to the rectum and exposure to blood.
Human papilloma virus
Vaccines have been developed that provide protection against strains 16/18 of human papilloma virus (HPV). These strains of HPV are high risk for cervical and anal cancer.
The HPV vaccines work best in people who have never been exposed to HPV. They do not help “cure” HPV in people who already have the virus. Because of this, the NHS is recommending that the vaccine is only given to girls aged twelve and 13 who are not yet sexually active and haven’t been exposed to HPV.
There are currently no trial results to show if the vaccines are safe and effective in boys and men, or in people with HIV, although such studies are now underway.
Some people are paying for HPV vaccination from private doctors. If you are considering doing this, make sure that the doctor tests you to see if you are already infected with HPV.