HIV update - 15th May 2019

Health problems while travelling in Africa

The importance of people with HIV getting medical advice before a trip to a tropical country is emphasised by a new study. The researchers tracked 264 HIV-positive people, all of whom were living in France and who travelled to an African country, most often their country of birth. All were taking HIV treatment and 94% had an undetectable viral load.

Travel-related health problems were quite common. Overall, 38% had an issue, either during the trip or in the months that followed. Half of those with a health problem sought medical care.

The most common health problems were diarrhoea and gastrointestinal complaints (26%), respiratory illnesses (18%) and malaria (15%). One woman died of malaria, which can be more severe if your CD4 cell count is low.

Health problems were more common in people who had not received medical advice about their journey than people who had. People whose viral load was low but not completely undetectable (above 50 copies/ml) were also at greater risk of health problems.

Medical advice before travelling can cover the vaccinations you need as well as preventive drugs against malaria. Doctors may also provide advice on food and water safety, avoiding insect bites and other issues, depending on which country you are going to.

Taking part in ‘cure studies’

Research towards future HIV therapies that aim to boost the immune system, totally clear HIV from the body or keep HIV under control without taking conventional antiretroviral therapy has gained momentum in the last few years. We usually call these ‘cure studies’, although not all researchers think that is the right term to use.

Clinical trials of these strategies often enrol people living with HIV, who may be asked to try the experimental therapy and to stop taking their antiretroviral therapy (usual HIV treatment). The researchers can then closely monitor their body’s response to see if there are any signs that the experimental therapy has some effect. This is called an ‘analytical treatment interruption’.

Should you consider taking part in a study where you’ll have an analytical treatment interruption? A group of experts recently made recommendations on how these studies should be done.

They said it was vital that participants understand the potential benefits and risks of taking part. The studies being done are at a very early stage and you are unlikely to personally benefit. Taking part will help advance HIV science, but almost certainly not cure you of HIV.

Stopping conventional HIV treatment could harm your health, even if the researchers try hard to manage these risks. Some people who have taken part in these studies have fallen ill or developed drug resistance.

The experts said that people taking part should be individuals in good health, doing well on HIV treatment and expected to be able to tolerate a period of high viral load. For people who have other health problems on top of HIV or have had a serious HIV-related illness in the past, an analytical treatment interruption would probably be too risky. It would also not be advised for people who aren’t ready to use preventative measures with their sexual partners – with the high viral load, there would be a potential of HIV transmission.

Their recommendations also cover how often viral load should be monitored during a treatment break and at what point conventional antiretroviral treatment should be restarted.

For more information, read NAM's factsheet 'Thinking about joining a clinical trial?'

Undiagnosed HIV in African communities in London

The rate of undiagnosed HIV infection among heterosexual black Africans living in London remains unacceptably high, according to a new study.

In late 2016, researchers visited social and commercial venues popular with black African communities across London. A total of 604 people completed surveys and most of them also gave a saliva sample to be tested for HIV.

Overall, 7% of women and 10% of men were HIV positive. But around half of the people whose test result was positive were not aware of their infection – in the survey, they had said that they did not think they had HIV.

The researchers say that a greater range of HIV testing services are needed to encourage more people to test and to have access to medical treatment if they have HIV.

Switching to generic drugs could save billions

An analysis by Public Health England found that prescribing generic drugs as soon as they become available could save the NHS around £7 billion between 2018 and 2033.

Pharmaceutical companies usually hold the patent for a drug for a set period, usually 20 years, which means they have the exclusive right to sell it under a single brand name. After the patent expires, other companies are free to manufacture and distribute the same drug under different names, although its active ingredients remain the same. These are called generic drugs and are usually cheaper than the branded drugs.

The NHS prescribes generics where possible. This trend is likely to continue over the next decade as many of the current drugs will be coming off patent.

At the moment, the lifetime cost of antiretroviral treatment varies from £193,000 to £404,300 in the UK, assuming an average life expectancy for people living with HIV of 78 years. Generic drug costs were estimated as being 10% or 50% of the price of branded products. 

The researchers found that if doctors switched to generics rapidly, this would enable substantial cost savings. The lifetime cost of treatment would fall by between 42 and 69%, to between £73,000 and £125,000 if current patterns of drug prescription are maintained.

However, the researchers’ data on current prescribing patterns actually come from 2016. Since then, many people have switched to integrase inhibitors and these drugs will come off patent later than other drugs. Also, injectable drugs are likely to be introduced soon and these will probably still be patented until around 2033, so potential savings might be lower than predicted.

For more information, read 'Generic medicines' in NAM’s booklet 'Taking your HIV treatment'.