Pre-exposure prophylaxis reduces HIV risk for gay men
Results from a big international trial showed that taking pre-exposure prophylaxis (PrEP) reduced the risk of contracting HIV by 44%. It appears that even bigger reductions in risk occurred in men who took the treatment as prescribed.
The trial was called iPrEx and involved 2500 gay men in nine different cities. All the men were HIV-negative when they entered the study, and had a high risk of contracting HIV.
They were randomised into two groups. One was given Truvada (tenofovir and FTC), the other a placebo. They were counselled about safer sex and given condoms. The men were instructed to take the drug every day, regardless of whether they expected to have sex that day.
During the trial they were regularly tested for HIV and other sexually transmitted infections. The average length of participation in the study was 14 months.
There were 100 HIV infections during the study period, and 64 of these were among the men taking the placebo.
The researchers therefore calculated that taking Truvada reduced the risk of infection with HIV by 44%.
Even better results were seen in men who took at least 90% of their doses. With this level of adherence, Truvada reduced the risk of infection with HIV by 73%.
None of the people who became infected with HIV had resistance to anti-HIV drugs. The treatment was generally very safe and the most commonly reported side-effects were nausea and vomiting, but changes in kidney function were seen in some people.
Although they believe the results to be promising, HIV prevention experts are emphasising that pre-exposure prophylaxis is not a first line of defence against HIV. More research will need to be carried out before PrEP can be used routinely, and it's important to stress that this trial does not provide any evidence to support the use of occasional doses around the time of sex.
For more information on the trial results, view the full news report on aidsmap.com or visit the Global iPrEx website.
The global HIV epidemic
Over the last ten years, the number of new infections has fallen by 20%, and thanks to increasing access to antiretrovirals, HIV-related deaths have also fallen by a fifth since 2004.
UNAIDS estimates that around the world there are now 33.3 million people living with HIV. It’s thought that 2.6 million people were newly infected with HIV in 2009 and that 1.8 million people died because of the infection.
A total of 5.2 million people are now taking HIV treatment, with 1.2 million people starting treatment last year.
But the report showed that there’s still much to be done.
For every person who started treatment, two became infected with HIV. There are also 10 million people waiting to start anti-HIV drugs.
Laws are hampering prevention work with men who have sex with men and injecting drug users. In addition, levels of risky sex and HIV diagnoses are high among gay men in Europe and America.
For more information on the new statistics, view the full news report on aidsmap.com or visit the UNAIDS microsite.
HIV and smoking
Chronic obstructive pulmonary disease (COPD) is a major consequence of smoking for patients with HIV, Italian research has shown.
The disease covers a wide range of lung problems, ranging from ‘smoker’s cough’ to emphysema, a condition which is often fatal.
Italian researchers compared rates of lung diseases in HIV-positive and HIV-negative smokers. They found that people with HIV were more likely to have a cough, experience breathlessness, and have COPD.
“HIV patients, especially smokers, should be regularly screened for respiratory disease,” the researchers concluded.
HIV treatment update included a feature on smoking in issue 193, which is now freely available on our website.
Efavirenz side-effects
Efavirenz can cause sleep and mood problems, especially during the first few weeks of treatment. These side-effects usually lessen or go away, but some people find the drug intolerable and need to change treatment.
Researchers wanted to see if some patients had long-term efavirenz side-effects which were so mild that they didn’t notice them.
They therefore designed a twelve-week ‘cross-over’ study. It included 58 patients, and all had been taking efavirenz for at least three months.
The patients were divided into two groups. Half continued to take efavirenz, but the others switched to etravirine (Intelence). After six weeks the two groups switched to the alternative treatment. The study was ‘blinded’ so neither the patients nor their doctors knew whether they took efavirenz in the first part of the study, or the second.
All the patients completed questionnaires enquiring about their sleep and mood. They were also asked to say if they preferred treatment during the first six weeks or the second six weeks.
Almost equal numbers of patients expressed a preference for efavirenz and etravirine. There was no difference in quality of mood or sleep when people were taking the drugs.
However, lipid profiles were better when patients were taking etravirine.
For more information on side-effects, visit the Side-effects topics page on our website, or download our patient information booklet.
Kidney transplant
Three years after transplant 88% of patients were still alive, and the transplanted kidney was still functioning in 78% of individuals.
The research involved 150 patients. Overall survival rates were only slightly worse than those seen in HIV-negative transplant patients in the US.
The researchers believe that these “favourable results were influenced by careful patient selection, adherence to clinical management protocols…and close coordination among the multidisciplinary teams.”
The current issue of HIV treatment update includes a feature article on HIV & the kidneys. This is not yet available on our website.
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