HIV treatment – changing treatment
Research conducted in London shows that HIV treatment is becoming easier to tolerate.
Doctors and pharmacists reviewed the medical records of people who received care at the Chelsea and Westminster Hospital between 2009 and 2011 and who were taking HIV treatment.
They found that 12% of patients switched treatment in this period. The proportion of people who changed treatment each year was 8%. This is much lower than the 20% rate seen in 2006, when an earlier study looked at this issue.
Most treatment changes were because of side-effects. Other reasons included changing to a simpler combination; joining a clinical trial; an increase in viral load; or to avoid interactions with other drugs.
People were especially likely to stop taking three older drugs: Kaletra (lopinavir/ritonavir), AZT (also in Combivir) and saquinavir (Invirase).
Few people stopped taking the drugs which are now most commonly used in routine HIV care.
The study shows that there have been significant improvements in HIV treatment in recent years. If you are having problems with your treatment, such as side-effects, it makes good sense to tell your doctor or another member of your HIV care team. It’s nearly always possible to find a solution to problems with treatment, including changes to more tolerable or manageable combinations.
Want to talk to your doctor about HIV treatment, but not sure where to start? Try our ‘Talking points’ tool before your next appointment: www.aidsmap.com/talking-points
Living with HIV – mental health
The study involved over 2000 people, receiving care in HIV clinics in major UK cities. Approximately a quarter of participants had a depressive disorder of some kind, including 20% of participants identified as having a major depressive disorder.
Rates of depression were especially high among people who were unemployed and unable to work because of illness or disability.
There was also a high prevalence of depression among people who did not have enough money to live on.
Lower levels of education were also associated with depression, and prevalence was especially high among people with little social support.
The researchers found that depression was associated with poorer adherence to HIV treatment and that people with depression were less likely to have an undetectable viral load.
You can find out more about depression and HIV and the help available to you in our booklet HIV, mental health and emotional wellbeing. A member of your healthcare team will be able to talk to you about treatment options.
Young people living with HIV – adherence
To get the most benefit from HIV treatment, it’s important to take it as prescribed, in the right quantities, at the right time, every day. Several studies have shown that younger people sometimes have significant problems adhering to HIV treatment.
There have previously been some trials of giving financial incentives to people to encourage healthy behaviours such as testing for HIV and other sexually transmitted infections, including some research highlighted at the International AIDS Society conference last year.
St Mary’s Hospital in London is trialling motivational interviewing and giving small financial incentives with a small number of younger people – aged 16 to 23 – to try to improve their engagement with the clinic and their treatment adherence.
The people who were offered these incentives had a long history of adherence difficulties and traditional methods of support had not worked. At the start of the trial period, median CD4 count in the group was 30 cells/mm3.
There was some evidence that these interventions worked, with five of the eleven participants maintaining an undetectable viral load for six months. The median CD4 count in the group after the programme was 140 cells/mm3.
Partner violence towards women with HIV
Women attending the clinic were asked to complete a questionnaire asking if they had ever been humiliated or emotionally abused by a partner; been afraid of a partner; been raped or forced into sexual activity by a partner; or been kicked, hit, slapped or physically hurt by a partner. The questions related to both current and former partners.
Overall, 52% of women had experienced violence of some sort, including 14% when they were pregnant and 14% in the previous twelve months.
Experiencing violence was associated with poor mental health. The researchers want HIV healthcare professionals in the UK to be more aware of the issue and to screen women in their care for intimate partner violence.
Hepatitis C treatment
Researchers from around the world gathered in Barcelona last week to discuss advances in treatment for hepatitis C.
Hepatitis C can be cured, but traditional therapy – with 48 weeks of pegylated interferon and ribavirin – doesn’t always work. People who are co-infected with HIV often have a poor response to this treatment. The side-effects are often hard to live with.
Several new drugs have been developed or are in clinical trials that improve treatment responses. Two hepatitis C protease inhibitors have already been approved, but they need to be taken in combination with standard therapy.
The research presented to the Barcelona conference was conducted in people with hepatitis C mono-infection (people who do not also have HIV). But their findings will also be of interest to people with HIV and hepatitis C co-infection. There’s currently a lot of debate about how best to use the new hepatitis C drugs in people with HIV, and what the benefits and complications are likely to be. Nevertheless, there’s a lot of optimism that these treatment advances will have real benefits in a few years' time.
One study showed that both the approved hepatitis C protease inhibitors are associated with high rates of side-effects in people with liver cirrhosis, the group of patients who can least afford to wait for newer drugs. Approximately half the study participants treated with telaprevir experienced a severe adverse event, as did 38% of those taking boceprevir. This study was especially interesting as it was conducted in a ‘real world’ setting, outside the context of a clinical trial.
However, arguably the most exciting studies were those which were looking at new drugs which offer the prospect of interferon-free therapy.
Pegylated interferon is the cornerstone of current treatment. But it is administered by injection and often causes unpleasant side-effects which can be so severe that they lead to treatment being discontinued.
Hepatitis C treatment is a fast-moving area of medicine. There are regular reports on aidsmap.com about the latest developments, and information about what these mean for people with HIV co-infection. Visit our website for news reporting from the International Liver Congress in Barcelona.