HIV Weekly - 16th January 2013

Side-effects

New research suggests that the anti-HIV drug raltegravir (Isentress) causes mild muscular pain.

Raltegravir belongs to a class of drugs called integrase inhibitors. It has a powerful anti-HIV effect, and can be taken by people starting HIV treatment for the first time and by people with experience of antiretroviral therapy.

The side-effects most associated with raltegravir are nausea and headache. These tend to be mild and usually occur soon after starting therapy with the drug, going away of their own accord.

Clinical trials conducted during the development of raltegravir showed that a very small number of people developed muscular side-effects.

Because of this, Australian doctors compared the risk of muscular side-effects between people taking raltegravir and people taking other anti-HIV drugs.

A total of 318 people were included in the study. Half were treated with raltegravir.

Overall, 28% of study participants had muscular side-effects. The prevalence was much higher among those treated with raltegravir (37 vs 19%).

The researchers found that people taking raltegravir were much more likely than people taking other drugs to develop muscle pain and soreness (19 vs 3%).

But they stress that this side-effect is unlikely to mean that someone would need to change treatment.

Raltegravir was also associated with an increased risk of muscle weakness.

The researchers recommend that people taking raltegravir should be monitored for muscular side-effects.

Want to talk to your doctor about HIV treatment, but not sure where to start? Our online Talking points tool is designed to help you prepare for appointments and support those conversations.

Adherence – taking your HIV treatment

Memory problems and neurocognitive impairment are associated with poor adherence to HIV treatment, doctors in the United States have found.

Adherence – taking your treatment properly – is very important to the success of HIV treatment. The best outcomes are seen in people who take all, or nearly all, of their doses at the right time and in the right way.

Poor adherence is associated with an increase in viral load, a fall in CD4 cell count and an increased risk of developing resistance or becoming ill.

Simple forgetfulness is the main reason people report for sometimes not taking their treatment.

In most cases this is nothing to worry about. However, some research has shown that people with HIV have an increased risk of memory problems and neurocognitive impairment.

Doctors wanted to see if neurocognitive impairment was associated with poorer treatment adherence.

Their research involved 80 people taking HIV treatment. Half were assessed as having some form of neurocognitive impairment.

Such impairment and poorer “working” memory were both risk factors for missing doses of HIV treatment.

Poorer adherence was also associated with the detection of HIV in cerebrospinal fluid. This could mean that HIV is replicating in the brain, causing inflammation that could lead to problems with memory.

The doctors who conducted the study recommend that people should have their cognitive function assessed before starting HIV treatment. This would help identify those in need of adherence support.

Support with adherence should be available through your HIV clinic. You can also find some advice on how to improve your adherence here.

HIV and TB

There has been a big fall in the number of new cases of tuberculosis (TB) diagnosed among heterosexual people living with HIV in England and Wales.

TB is a major cause of serious illness and death in people with HIV. Many heterosexual people living with HIV in the UK are originally from countries where prevalence of HIV and TB is very high.

Researchers monitored new cases of TB among heterosexual people living with HIV in England and Wales between 2002 and 2010.

Over 45,000 people were included in the study and approximately 9% were diagnosed with TB.

The majority – 84% – of people diagnosed with TB were from sub-Saharan Africa.

However, there was a steep fall in the rate of diagnoses overall.

The researchers believe this was partly because people are starting HIV treatment at higher CD4 cell counts. This provides protection against TB.

However, they warn that there is no room for complacency. Rates of TB among people with HIV are still many times higher than those seen in the general population.

In addition, their results showed that large numbers of people had their HIV infection diagnosed late, when they were ill with TB.

For more information, you may find our HIV & TB booklet helpful, or you could view our three leaflets about HIV & TB in our illustrated series ‘The basics’.