HIV treatment as prevention
Secretary of State, Hillary Clinton, said the aim was an “AIDS-free generation”.
Clinton said: “Treatment doesn’t take away from prevention, it adds to it. So let’s end the old debate over treatment versus prevention and embrace treatment as prevention.”
A combination approach to HIV prevention was advocated by Clinton. She highlighted three measures shown to reduce the risk of infections:
- Testing and treatment to prevent mother-to-child transmission.
- Voluntary male circumcision.
- Treatment as prevention.
The HPTN 052 study showed that earlier treatment reduced the risk of HIV transmission by 96%, and another US-funded study has confirmed that treatment before the onset of serious AIDS-defining illness or immune deficiency substantially reduces the risk of developing AIDS or dying.
For more evidence-based information on HIV treatment as prevention, or other aspects of prevention, visit our online resource Preventing HIV.
HIV treatment – side-effects
Raltegravir is a type of anti-HIV drug called an integrase inhibitor and it generally only causes mild side-effects.
However, the ‘Warnings and Precautions’ section of the drug’s information leaflet now cautions that rare cases of Stevens-Johnson syndrome, a severe and potentially life-threatening skin reaction, have been associated with the drug, as have severe allergic reactions, or hypersensitivity reactions.
People taking raltegravir are therefore advised to contact their doctor immediately if they develop a rash.
People should stop taking raltegravir at once and seek medical attention if this rash is accompanied by any of the following symptoms: fever; feeling generally unwell; extreme tiredness; aching in muscles or joints; blistering; mouth ulcers or lesions; inflammation of the eyes; swelling of the eyes, lips or mouth; facial swelling; breathing difficulties; yellowing of the skin or eyes; dark urine; pale stools; nausea; vomiting; loss of appetite; pain, aching or sensitivity on the right-hand side, below the ribs.
For more information on raltegravir, visit our A to Z of antiretroviral drugs at www.aidsmap.com/drugs.
HIV treatment – resistance
Modern HIV treatment combinations that include tenofovir (Viread) have a low risk of resistance, new research suggests.
The aim of HIV treatment is an undetectable viral load. However, if HIV isn’t fully suppressed then the virus can develop resistance to the drugs used to treat it.
Modern HIV drugs are generally very powerful, easy to take and cause only mild side-effects. They are therefore associated with a lower risk of resistance than earlier generations of anti-HIV drugs.
All the combinations they looked at were based on either 3TC (lamivudine, Epivir) or FTC (emtricitabine, Emtriva). They were then grouped according to the other drugs taken in the combination.
Over six years, 16% of people who were taking a combination that included both AZT (zidovudine, Retrovir) and efavirenz (Sustiva) developed resistance. This compared to between 5 and 9% of patients treated with other combinations.
Two-thirds of all cases of resistance developed when patients had a viral load between 50 and 500 copies/ml.
The researchers think this finding is “remarkable” and suggest that people who experience a low rebound in their viral load when taking treatment should be closely monitored for resistance.
The research underlines the effectiveness of modern HIV treatment. AZT is no longer recommended for routine long-term use in countries like the UK. But the findings of this study are important for low- and middle-income countries where AZT is a backbone of HIV treatment.