HIV treatment and infectiousness
The international study – called HPTN 052 – involved 1736 male-female couples where one partner was HIV-positive and the other HIV-negative.
Participants were randomised into two groups.
The HIV-positive people in the first group started HIV treatment immediately, and in the other group they waited until their CD4 cell count fell to 250.
The study started enrolment in 2005 and was meant to continue until 2015.
However, the study was stopped early because its findings showed that HIV treatment dramatically reduced the risk of transmission to the HIV-negative partner.
There were 28 new HIV infections that were genetically linked to the HIV-positive partner – 27 of these were in couples where the HIV-positive partner wasn’t taking HIV treatment.
This result suggests that HIV treatment was reducing the risk of transmission by 96%.
UNAIDS described the results as “a serious game changer”.
The use of HIV treatment as prevention has been a hot topic for a number of years.
Debate was kick-started by the ‘Swiss statement’.
For this to be the case, they said a person needed to:
- Be taking antiretroviral treatment and have had an undetectable viral load for at least six months.
- Take their treatment properly.
- Not have any other sexually transmitted infections.
The research their advice was based on was in heterosexual couples and the authors have since said that the statement covered only heterosexual transmission.
Not all doctors agreed with the statement, but there is a growing consensus that effective treatment does dramatically cut the risk of HIV transmission.
But prevention advice still stresses the importance of condom use. If you and an HIV-negative partner are having unprotected sex, or are thinking about it, it’s important to talk to each other about the possible risks and implications, so that you can reach an informed decision that you’re both comfortable with.
Condoms, including female condoms, are a very effective method of preventing transmission of HIV, other sexually transmitted infections and unplanned pregnancy.
If you find using condoms difficult, find it difficult to use them all the time, or are thinking of stopping using condoms to start a family, it’s a good idea to talk to your HIV doctor, or another member of your healthcare team.
Non-dangerous contamination of darunavir
A warning has been issued that some batches of the protease inhibitor darunavir (Prezista) may have experienced non-dangerous contamination.
Janssen, the company which makes the drug, said that about 2000 bottles of the 400mg and 600mg tablets had been contaminated with a wood preservative.
These tablets have been supplied to five countries – including 400mg tablets in the UK.
The contamination causes a musty or mouldy smell.
If you notice this, you’re recommended to contact your HIV pharmacist immediately. Alternatively, Janssen in the UK can be contacted on 0800 032 3013.
However, it’s been stressed that patients must not stop taking their HIV treatment.
The contamination isn’t toxic, but four people have experienced temporary stomach complaints that may be related to the problem.
As a precaution, Janssen has recalled five batches of Prezista 400mg or 600mg tablets supplied to pharmacies in the UK, Ireland, Germany, Austria and Canada, all of which were handled by the same supplier.
The recall does not apply to Prezista 75mg, 150mg and 300mg tablets.
HIV care – moving clinic
The researchers think that some patients drop out of HIV care when they move, and experience HIV disease progression as a result.
Their study involved people who received continuous care from their clinic; people who moved away but then came back to the clinic; and people who dropped out of care – were ‘lost to follow-up’ – but subsequently came back to the clinic.
Average CD4 cell counts increased for patients who remained in continuous care.
However, the CD4 counts of patients who moved away were much lower when they returned to the clinic. This was also the case for returning patients who had been lost to follow-up.
In addition, returning patients were more likely to develop an AIDS-defining illness.
The researchers found that only a third of patients who moved had their notes requested by a new clinic.
This led investigators to conclude that many patients effectively dropped out of HIV care.
“Efforts to transfer care seamlessly to other HIV care centres needs to be reinforced to avoid negative health consequences,” stress the researchers.
You can read a feature article ‘Lost to care - the mystery of the disappearing patients’ on our website. To find HIV clinics and services local to you, visit our online e-atlas.
HIV and TB
Tuberculosis (TB) is the single most important cause of serious illness and death in people with HIV across the world.
New research has shown that a 12-week course of combination antibiotic treatment is an effective therapy for latent TB (TB that isn’t currently causing illness). However, latent TB may develop into active TB if the immune system weakens, due to malnutrition or HIV infection, for example.
Preventive treatment with an anti-TB drug called isoniazid can reduce the risk of latent TB turning into active disease. This treatment is normally taken for six to nine months.
But researchers wanted to see if the duration of treatment could be shortened to just 12 weeks if isoniazid was combined with a newer anti-TB drug called rifapentine.
They therefore compared the effectiveness of this treatment to standard, single-drug isoniazid therapy.
Results showed that 12 weeks of treatment with the new combination was just as effective as longer-term isoniazid therapy.
“New, simpler ways to prevent TB disease are urgently needed, and this breakthrough represents one of the biggest developments in TB treatment in decades,” said one expert.
Further research is needed to see if the combination is effective in patients with HIV.
NAM’s patient information booklet HIV & TB is available on our website in English, French, German, Italian, Portuguese and Spanish.