HIV treatment
New research shows why it is important to have and to use HIV treatment guidelines. HIV is a very complex and fast-moving area of medicine. Guidelines exist to make sure that people living with HIV receive the best possible treatment and care. Those in the UK are developed by the British HIV Association, similar guidelines exist in other countries and the World Health Organization also publishes guidelines.
Swiss doctors looked at the factors associated with people taking non-recommended combinations of anti-HIV drugs, such as: the use of two boosted protease inhibitors; treatment with three NRTIs; or the combined use of d4T (stavudine, Zerit) and ddI (Vivex). These combinations can either cause serious side-effects, or don’t have the potency to suppress viral load to undetectable levels.
The study period was 2006 to 2010. Only small numbers of people were taking these non-recommended combinations. Their use was related to certain factors.
People with more advanced HIV disease and extensive experience of antiretroviral therapy were especially likely to be taking two boosted protease inhibitors. This suggests that the combination was being used as ‘salvage therapy’.
People who had a high risk of cardiovascular disease were more likely to be treated with three NRTIs. This is perhaps because doctors thought this combination would be a safer option than some other combinations, which can increase cholesterol.
The number of people taking non-recommended combinations had fallen dramatically by 2010.
Concerns about lipodystrophy or cardiovascular disease were important reasons for changing to recommended combinations.
Changing to recommended treatment had benefits for the patients. People who switched from triple-NRTI therapy were more likely to achieve an undetectable viral load, and adherence improved after people stopped taking the d4T/ddI combination.
Want to talk to your doctor about your HIV treatment but not sure where to begin? Try the Talking points tool on our website before your next appointment!
HIV and hepatitis C
It showed that men with both HIV and hepatitis C had poorer cognitive function than men who only had either HIV or hepatitis C, as well as compared to men with neither virus.
Infection with HIV has been associated with cognitive impairment. A similar association has been seen in people with hepatitis C.
Doctors in San Francisco wanted to see if co-infection with HIV and hepatitis C was related to impaired cognitive function in people who were doing well on HIV treatment.
They therefore designed a study involving middle-aged men in their care, in four groups:
- Men who had HIV and hepatitis C (co-infection)
- Men who had HIV but not hepatitis C (HIV monoinfection)
- Men who had hepatitis C but not HIV (hepatitis C monoinfection)
- Men with neither HIV nor hepatitis C (control group).
All the participants living with HIV were taking antiretroviral therapy with an undetectable viral load. None of the participants had liver cirrhosis or clinical depression.
The researchers used a range of tests to assess mental health status and cognitive functioning.
The results showed that the group with co-infection were more likely than other groups to have mild depression.
Overall, two-thirds of people with co-infection were found to have some form of cognitive impairment – a much higher rate than that seen in the other study groups.
“We were able to detect a mild, yet significant impairment in the cognition among the coinfected group,” write the investigators. “Coinfected subjects performed poorly on the attention, executive function, fine motor function and visual and verbal learning memory tests, with significantly lower…scores than either controls or monoinfected subjects.”
HIV, diet and nutrition
Diet and nutrition are central to good health, and eating a healthy diet is especially important for people living with HIV.
In countries like the UK, the emphasis of dietary advice is often focused on avoiding fatty foods and eating plenty of fresh fruit and vegetables to reduce the risk of cardiovascular disease.
But in poorer countries, many people are often hungry and their diet doesn’t provide the nutrients essential for health.
This latest research involved 800 people. It showed that having a more diverse and nutrient-rich diet before starting HIV treatment was associated with a reduced risk of serious illness and death.
For more information on eating well, you may find our Nutrition booklet helpful. It’s available in English and French.
New anti-TB drug: corrected version
The anti-tuberculosis (TB) drug bedaquiline has been recommended for fast-track approval in the US.
TB is the single biggest cause of serious illness and death in people with HIV around the world.
The infection is a global health problem, and there is particular concern about increasing rates of drug-resistant TB. New anti-TB drugs are therefore urgently needed.
Bedaquiline has been specially developed for the treatment of drug-resistant TB. It was shown to be safe and effective in clinical trials, improving treatment response rates.
The anti-HIV drug efavirenz (Sustiva, also in Atripla) does not reduce levels of bedaquiline. (Last week's HIV weekly incorrectly stated that there is an interaction.)
On our website you can find information for people living with HIV and TB (for example the HIV & TB booklet and three leaflets in our illustrated series The basics) and information for healthcare workers in resource-limited settings.
Editors' picks from other sources
Outrage sparked by Brighton University film showing
from The Argus
A university professor has been criticised for suggesting to his students that HIV does not cause Aids. Activists are planning to protest against the screening of a controversial 'AIDS denialist' film at the University of Brighton on Wednesday, December 12.
Six Promising HIV Drugs in the Pipeline
from The Body Pro
What new HIV medications do we have to look forward to over the next few years? How will these newer drugs improve upon the older ones? To shed some light on these questions, Roy Gulick, M.D., recently provided an overview of drugs in development.
Botswana: Public health bill shocking and regressive
from International HIV/AIDS Alliance / Botswana Network on Ethics, Law and HIV/AIDS
The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) is shocked by the introduction of a Public Health Bill which our Parliament is currently debating. This Bill has some provisions that have no place in a democratic and modern day Botswana. It has provisions that are counter-productive, discriminatory, unconstitutional and barbaric.
The latest word on hormonal contraception and HIV
from IRIN Plus News
In early 2012, the UN World Health Organization (WHO) announced it could not conclusively determine whether hormonal contraceptive injections increased the risk of HIV transmission. Almost a year later, WHO is still struggling to communicate clear guidance for women using injectable contraceptives, who are largely in the dark about these concerns, say activists, even as scientists are developing a clinical trial that could finally offer answers.