Eviplera works well in people starting treatment
The new combination pill Eviplera (rilpivirine/tenofovir/FTC) is safe and effective in people starting HIV treatment. Researchers compared outcomes between people starting therapy with Eviplera and those seen in people starting treatment with Atripla (efavirenz/tenofovir/FTC).
The study involved approximately 800 people who were starting HIV therapy for the first time. Their average CD4 cell count was 390 and a third had a viral load above 100,000 copies/ml.
Tests 48 weeks after treatment was started showed that 86% of people taking Eviplera had an undetectable viral load, as did 82% of the people taking Atripla.
The researchers then looked at outcomes according to baseline CD4 cell count. They found that 88% of people taking Eviplera with a CD4 cell count above 200 achieved an undetectable viral load, as did 82% of people taking Atripla who had a CD4 cell count above this level. Rates of viral suppression among people with a baseline count below 200 were the same for the two drugs (72 to 71%).
Outcomes according to baseline viral load were also examined. Among people with a viral load below 100,000 copies/ml, 89% of the people taking Eviplera achieved virological suppression, as did 82% of the people taking Atripla. Rates of viral suppression for people with baseline viral loads above 100,000 copies/ml were 80 and 82%, respectively.
Separate research showed that Eviplera has a more favourable lipid profile than ritonavir-boosted protease inhibitors.
HIV and bone loss
There’s now a lot of research showing that bone loss and low bone mineral density can be complications of having HIV.
The exact reasons are unclear, but seem to include a combination of traditional risk factors (such as smoking, heavy alcohol intake, low body weight and low testosterone), the damage caused by HIV and the side-effects of some anti-HIV drugs.
In the US study, researchers compared bone loss and bone mineral density between 47 people with HIV who had not taken HIV treatment (treatment naïve) and had high CD4 cell counts and 41 HIV-negative people in a control group.
At the start of the study, the two groups had similar bone density, but the people living with HIV had higher levels of bio-markers of inflammation in their blood.
One year later, 93% of the people with HIV had experienced bone loss compared to 73% of the control group. Osteoporosis and osteopenia were observed in 21% of the HIV-positive group and 6% of the control population.
Higher levels of the inflammatory marker IL-6 were associated with bone loss.
HPV vaccination
Persistent infection with high-risk strains of HPV in the cervix can cause cell changes associated with cervical cancer.
A vaccine is available that provides very high levels of protection against these HPV strains. HPV is very common and most people become infected with HPV soon after they become sexually active, so vaccination is recommended by adolescence. In the UK, HPV vaccination is offered to all girls aged 12 to 13.
But researchers were concerned that the immune damage caused by HIV could mean that girls with HIV would have an inadequate response to the vaccine.
They therefore looked at the vaccine responses of over 400 girls with HIV aged between 9 and 13 years.
Two-thirds had an undetectable viral load.
All the girls received the recommended three doses of the vaccine and they were followed-up for two years.
In girls with an undetectable viral load, antibody levels were between two and three times that of girls with detectable levels of HIV.
Monitoring 7 and 24 months after vaccination showed that the girls had lower levels of protective antibodies against the four types of HPV covered by the vaccine than would be expected for HIV-negative girls.
But the vaccine response was similar to that observed in older women with HIV in other studies and the researchers therefore think it would be adequate to protect the girls from infection with the HPV strains.
Other news
Hepatitis C treatment for people with HIV
People with HIV who have hepatitis C virus (HCV) co-infection have a poorer response to interferon-based hepatitis C therapy if they have a low CD4 cell count, high hepatitis viral load, are older and have an unfavourable IL28B profile. Researchers believe this group may especially benefit from therapy with a new direct-acting anti-HCV drug. Read the full news story on aidsmap.com.
Pregnancies among women with HIV
Only a fifth of pregnancies among women with HIV are planned, US research shows. A planned pregnancy was associated with discussing pregnancy and conception with healthcare workers. Read the full news story on aidsmap.com.
Editors' picks from other sources
HIV-positive campaigner recognised in Pink List 2013
from Beyond Positive
One of the few public figures who is HIV positive, Matthew Hodson, chief executive for the gay men’s health charity GMFA, has been acknowledged in this year’s Independent on Sunday Pink List.
Immigration bill: Theresa May defends plans to create "hostile environment"
from The Guardian
The home secretary, Theresa May, has defended plans to create a "hostile environment" for illegal migrants to Britain, as immigration lawyers warned her that a system of identity checks for all, including British citizens, would have to be introduced to enforce the government's moves to curb access to privately rented housing and to tackle alleged health tourists.
Visits to multiple HIV clinics linked to poorer outcomes
from Eurekalert Medicine & Health
Patients who received care at multiple HIV clinics – as opposed to only one – were less likely to take their medication and had higher HIV viral loads, a new study of almost 13,000 people with HIV in Philadelphia has found. The findings reinforce the notion that continuous care with one provider/clinic is optimal for outcomes.
The Caribbean makes strides in reducing HIV/AIDS in babies
from Christian Science Monitor
The Caribbean is on the verge of becoming the first region in the world to eliminate mother-to-child HIV transmissions. Thanks to an influx of foreign funding the region has led the world in the reduction of deaths from the disease and in cutting the spread of infection.