Long-term adherence
The Canadian study involved 1305 patients who were starting HIV treatment for the first time.
Treatment reduced viral load to undetectable levels in all the patients.
However, it subsequently rebounded in 21% of patients.
One of the factors associated with an increase in viral load was the amount of time that it had been suppressed to undetectable levels.
The risk of rebound was highest during the first year of treatment. But after that, the longer that viral load was suppressed to undetectable levels, the lower the risk of it increasing.
This was true at all levels of adherence.
Each month of viral suppression reduced the risk of rebound by about 8%.
This suggests that the consequences of missed doses may be less severe the longer a patient has been taking treatment.
Nevertheless, the researchers emphasise that people taking HIV treatment should aim to take all their doses correctly.
Even after taking into account the amount of time viral load was suppressed, those who took 95% or more of their doses were less likely to experience an increase in viral load than those with the poorest adherence.
There’s help available to you, to help you take your HIV treatment correctly. You can find out why adherence is so important in the NAM booklet on this subject. There are also tips to help you take your treatment, and information on where you can turn to for support.
Hepatitis C treatment for women with HIV and hepatitis C
They reviewed the results of three big trials looking at the safety and effectiveness of hepatitis C treatment in people with HIV.
Women were much more likely to stop treatment because of side-effects than men (24 vs 16%). In addition, more women than men experienced side-effects that led to treatment being changed (61 vs 48%).
Taking HIV treatment that included a non-nucleoside reverse transcriptase inhibitor (NNRTI) was associated with women stopping treatment.
Efavirenz (Sustiva, also in the combination pill Atripla) is an NNRTI that can cause mood and sleep problems. Higher blood concentrations of this drug have been seen in women. The investigators suggest that this may explain why therapy with NNRTIs was associated with treatment discontinuations in women.
Visit our website for more information on hepatitis C.
Nevirapine switch possible at any CD4 cell count
People taking HIV treatment who have an undetectable viral load can safely switch treatment to nevirapine (Viramune) when their CD4 cell count is at any level.
This is the latest advice from European drug regulators.
Nevirapine is an NNRTI. Patients who have a higher CD4 cell count when they start treatment with the drug have a risk of developing serious liver problems or an allergic reaction.
Therefore, women with a CD4 cell count above 250 and men with a CD4 cell count above 400 should not start HIV treatment with a combination of drugs that includes nevirapine.
However, a number of studies have shown that patients taking HIV treatment and who have an undetectable viral load can safely switch to nevirapine at higher CD4 cell counts.
HIV and the law
About 70% of HIV-negative and untested men supported criminalisation compared to 38% of HIV-positive men.
“These differences most likely reflect a shift in orientation toward criminal statutes on HIV transmission following seroconversion,” comment the investigators.
Support for use of the criminal law was especially high amongst men with the lowest levels of educational attainment, as well as those who did not identify as gay or bisexual.
A stronger sense of responsibility towards the sexual health of partners was associated with support for criminalisation.
The more unprotected sex men had, the lower their support for criminalisation.
A study conducted by Sigma Research in 2006 found similar attitudes among men who have sex with men (MSM) in England and Wales. This study showed that men who expected their prospective HIV-positive partners to disclose were especially likely to support criminalisation.
Both the US and UK researchers were concerned that prosecutions reinforced an assumption that people would disclose their HIV status. This doesn’t happen in the majority of cases. In addition about a quarter of gay men with HIV are undiagnosed.
NAM recently published a new, international resource on HIV and the criminal law. It is freely available on our website at www.aidsmap.com/law and will soon also be available to buy as a book. For more information, please contact us at info@nam.org.uk or call 020 7837 6988.
Videos of a recent meeting on the criminalisation of HIV exposure and transmission, held in Vienna in July, are available on our website.