HIV treatment – new drug
A new drug that combines three anti-HIV drugs in one pill has been approved in the US.
Complera combines FTC and tenofovir (Truvada) with rilpivirine, a new NNRTI that’s recently been approved in the States, where it’s called Edurant. European licensing of rilpivirine is expected later this year.
The combination drug is taken once daily and is only available for people starting HIV treatment for the first time.
Approval in Europe is expected in early 2012.
In addition, a once-daily version of nevirapine (Viramune), already approved in the US, has now been approved in Europe, and a new anti-hepatitis C protease inhibitor called boceprevir (Victrelis) received European approval earlier this month.
Prognosis – treatment with statins
Treatment with statins has been shown to reduce the risk of death for people taking HIV treatment.
Statins are best known as a treatment for high cholesterol. But they also have an anti-inflammatory effect.
Many of the diseases that cause serious illness and death in patients with HIV, for example cardiovascular disease, are linked to inflammation. Researchers at the HIV clinic at Johns Hopkins University in Baltimore wanted to see if taking statins could reduce the risks associated with this inflammation.
All 1538 patients in the study were doing well on HIV treatment and had an undetectable viral load.
A total of 16% of the participants were taking statins, and these people were found to have a significantly reduced risk of death during the study period compared to the patients who were not on statin therapy.
Treatment with statins was shown to reduce the risk of death by 67%.The reduction in risk was not due to the effect of the statins on heart disease; deaths due to a range of conditions were lower in the patients treated with statins.
The researchers are calling for more studies to examine the potential benefits of statin treatment for people with HIV.
Treatment and care – screening for other diseases
The study was primarily designed to compare outcomes between patients whose HIV care was paid for either by private or by public insurance.
Overall, patients with private insurance did better. But patients with public insurance were more likely to have other serious non-HIV-related health problems.
Those people were more likely to be obese, to have diabetes or high blood pressure, and to be co-infected with hepatitis B and/or hepatitis C.
They were also more likely to die of cardiovascular disease or liver disease than those with private insurance.
The researchers think that many of these deaths could have been avoided with proper screening and care.
Most patients in the UK receive their HIV care from specialist NHS clinics. Care should include regular monitoring for other health conditions and, where appropriate, referral to other medical specialists.
You can find out more about HIV medical monitoring in NAM’s booklet CD4, viral load and other tests.
Other conditions – high blood pressure
The importance of screening for other conditions was reinforced by the findings of a separate study. It showed that 15% of patients with HIV have high blood pressure.
Patients with HIV should have their blood pressure monitored regularly as part of routine clinic visits.
Researchers in Spain found that, when monitored in this way, 21% of their patients had high blood pressure (hypertension).
However, because patients are often anxious when seeing their doctor, their blood pressure can be temporarily higher than it is normally. Therefore, all patients with high blood pressure were referred for 24 hour monitoring.
A total of 39% of patients undergoing this monitoring outside the clinic were found to have normal blood pressure.
The researchers therefore calculated that the true prevalence of high blood pressure in their patients was 15%.
Risk factors for high blood pressure include older age and a family history of hypertension. The number of previous HIV treatment combinations was also a factor. The researchers believe this could be “an indirect measurement of antiretroviral treatment duration and cumulative drug-related toxicity”.
Treatment during pregnancy
There’s been a lot of debate protease inhibitors and the risk of pre-term delivery. Some studies have found an association, but others have not.
The latest research was conducted in Botswana. Just over a fifth of women treated with a protease inhibitor had a pre-term delivery (before week 37 of pregnancy), compared to 11% of women taking an NNRTI.
Both types of regimen were found to be very effective in reducing mother-to-child transmission of HIV. The researchers note that their study is not definitive and only had a small sample size. Other researchers, commenting on the study, suggest the results could have been influenced by a number of factors – for example, the point at which HIV treatment was started during the participants’ pregnancy (most pre-term deliveries were in women who started treatment later in pregnancy).
They call for further research and careful consideration of the issues raised by the study before any recommendations are made about HIV treatment during pregnancy.