Triple therapy for hepatitis C in people with HIV co-infection
Doctors in France looked at end-of-treatment responses among people with HIV and HCV co-infection who started triple-drug HCV treatment, often during routine care. Nearly three-quarters had an undetectable hepatitis C viral load after completing therapy.
The study adds considerably to our understanding of the safety and effectiveness of new anti-HCV drugs, as most of the existing data come from clinical trials, which usually have strict exclusion criteria, limiting the range of people in whom new drugs are tested.
Large numbers of people with HIV also have hepatitis C co-infection. Liver disease caused by this co-infection is now an important cause of serious illness and death.
HCV can be treated and cured. Until recently, therapy consisted of dual therapy with pegylated interferon and ribavirin. On the whole, people with co-infection do not do well on this combination.
However, two anti-HCV protease inhibitors have recently been approved – boceprevir (Victrelis) and telaprevir (Incivo or Incivek). Results from clinical trials show that adding these drugs to dual therapy can lead to improved treatment outcomes in people with co-infection. However, they have complex dosing schedules, can cause side-effects and have significant interactions with anti-HIV drugs.
French doctors wanted to examine outcomes in people treated with triple therapy in 'real-world' settings.
Their study sample consisted of 320 people, all of whom had the difficult-to-treat HCV genotype-1 infection. Among those who started triple therapy, 80 patients (70%) did so outside a clinical trial.
Many of the study participants had characteristics associated with poor treatment outcomes. Approximately a third had liver cirrhosis and 71% had taken a previous, unsuccessful course of dual HCV treatment.
A quarter of individuals had mental health problems – a possible contraindication for HCV treatment.
The majority of participants (71% overall, 84% outside trials) took treatment based on telaprevir, with 21% treated with boceprevir-based therapy. The remaining participants took another experimental drug.
At the end of treatment, 74% of people taking telaprevir-containing therapy had an undetectable HCV viral load, as did 60% of people taking boceprevir.
Treatment outcomes were best in people taking HCV therapy for the first time and in those with less advanced liver disease.
The researchers think these results are promising and are eagerly awaiting data showing how many people still had an undetectable HCV viral load 24 weeks after the completion of treatment – a sustained virologic response (SVR), considered a cure.
Interested in hepatitis and HIV? Visit our hepatitis C topics page for more resources, feature articles and news about hepatitis and HIV co-infection. We’re also working with ELPA, the European Liver Patients Association, on a hepatitis information website for patient advocates and professionals working in hepatitis in Europe – check it out at www.infohep.org
HIV and pregnancy
With the right treatment and care, the risk of HIV being passed on from a mother with HIV to her baby during pregnancy, birth or breastfeeding can be reduced to below 1%.
Researchers in Canada wanted to find out more about HIV-positive women’s experiences of pregnancy and motherhood.
They interviewed 33 women in the final stages of pregnancy and three months after giving birth.
It was apparent that some women felt that they were under the scrutiny not only of medical professionals but also family and friends. As well as receiving lots of advice, suggestions and queries about how they were managing their pregnancy, well-meaning relatives and acquaintances often took a particular interest in whether the women were breastfeeding or not. These questions felt intrusive, and women feared that their HIV status could be revealed.
A quarter of women also found themselves in contact with child protection services – who were concerned about the risk of HIV transmission – and often faced very critical questioning.
The researchers believe surveillance results in mothers having their authority challenged, undermined or taken away. They therefore called for moving away from a state of “social surveillance, monitoring, interrogation and criminalisation of HIV-positive mothers” to a situation in which mothering with HIV is normalised, accepted, and left alone.
Are you a woman living with HIV in the UK and pregnant, or thinking about having a baby? Or are you planning a pregnancy with a man who has HIV? Our online tool HIV & pregnancy is designed to provide you with key information: www.aidsmap.com/pregnancy
Editors' picks from other sources
Class claims dating sites disclose HIV statuses
from Courthouse News Service
Dating website conglomerate SuccessfulMatch.com posts its customers' HIV and STD statuses on thousands of its other websites, in violation of law and its own promises of confidentiality, a class action claims in the US Federal Court.
Man sentenced for 'HIV cure' fraud
from BBC Health
A man who was convicted of an online scam selling products that claimed to 'kill' the HIV virus has been sentenced to 240 hours community service. Admare Jinga used his base in Belfast to set up a company that advertised and distributed products overseas, particularly to his native Zimbabwe.
Some gay-rights activists say focus on marriage has undercut advocacy on AIDS and other issues
from Washington Post
Some activists say the [US] nationwide marriage campaign, while worthwhile, has diverted energy and resources from causes that may be harder to market – such as advocacy to combat HIV and AIDS and rights for transgender people. In the past, AIDS had been a unifying issue for the gay community but it is now a source of division – between those with good access to health care and those without it, and between those who are HIV positive and those who aren’t.