HIV treatment for children
The French study involved twelve children taking a combination of HIV treatment that included darunavir/ritonavir (Prezista), etravirine (Intelence) and raltegravir (Isentress).
All twelve children had extensive resistance to anti-HIV drugs.
Nevertheless, after a year of treatment, all but one had a viral load below 400 copies/ml, and average CD4 cell count had increased from 124 cells/mm3 to over 500 cells/mm3.
None of the children developed a serious HIV-related illness or died, and only one stopped treatment because of side-effects.
The researchers describe these results as “remarkable”. The same combination of drugs has been shown to have equally impressive results in adults with an extensive history of HIV treatment.
Support for HIV-positive injecting drug users
Other research has shown that injecting drug users are the group who are least likely to benefit from HIV treatment. Often, doctors are reluctant to start antiretroviral therapy in patients who inject drugs because of concerns that adherence levels are problematic in this group of people.
French researchers found that entering an opioid substitution programme (drug treatment using a prescribed substitute for the illicit drug) meant that at least 70% of injecting drug users who took HIV treatment had an undetectable viral load at least once.
However, overall adherence was poor, with only 42% reporting that they took all their treatment doses.
But the researchers found that the longer patients remained in opioid therapy, the better their chances of keeping their viral load undetectable. This was the case even if they took into consideration adherence of less than 100%.
HIV clinics can provide support and referrals to specialist services if you are concerned about any kind of drug use.
Hepatitis C treatment
The patients in the study had hepatitis C genotype 1 infection – one of the harder-to-treat strains of hepatitis C.
Many people with HIV are also infected with hepatitis C (co-infection), and liver disease caused by hepatitis C is now a significant cause of death in these patients.
Treatment for hepatitis C is available and consists of pegylated interferon and ribavirin. Treatment normally lasts for a year, and can cause unpleasant side-effects.
The objective of this treatment is a cure. This is defined as an undetectable hepatitis C viral load six months after treatment has been completed.
Patients who start treatment soon after they are infected with hepatitis C have the best chance of this outcome. Only about a third of HIV-positive patients who have long-term hepatitis C treatment achieve this outcome.
But new anti-hepatitis C drugs are in development, such as a protease inhibitor called telaprevir. It’s been investigated in studies where it’s used in combination with existing treatment.
One new study has shown that when these three drugs were used, over 80% of patients who were only infected with hepatitis C were cured of their infection.
Studies looking at the safety and effectiveness of newer treatments for hepatitis C are only just starting in people with HIV. These studies have been delayed because of concerns about interactions with anti-HIV drugs.
The July edition of HIV Treatment Update included a feature called 'Combinations and conundrums: the challenges of hepatitis C treatment'. It is now available to download as a PDF from our website.
You can subscribe to HIV Treatment Update via our online bookshop, or you contact us on info@nam.org.uk or 020 7837 6988. Subscriptions are free for people living with HIV in the UK.
Sexual health of HIV-positive gay men
Most people with HIV remain sexually active after their diagnosis. There’s now quite a lot of research showing that people with HIV, especially gay men, have high rates of sexually transmitted infections. Such infections can cause unpleasant symptoms, and if left untreated can increase the risk of HIV transmission.
Swiss researchers looked at rates of anal chlamydia in 147 gay men with HIV. All reported recent unprotected sex. They found the infection in 11% of these men. Having a greater number of sexual partners was associated with an increased risk of this infection.
This isn’t the first study to find high rates of anal chlamydia in HIV-positive gay men, and other researchers have suggested that routine tests for this infection should be performed as part of a regular sexual health check-up.
US travel ban to be lifted
Some good news to end on. From January 2010, people with HIV will be able to travel or migrate to the US.
The process to remove the travel ban started last July. But it’s been very complicated and involved the repeal of legislation and the removal of separate immigration rules. There were also lengthy periods of public consultation.
But these are now at an end. President Obama has announced the final removal of the ban. This means that people with HIV will no longer be subject to special restrictions if they wish to visit or migrate to the US.
The current restrictions will remain in place until early in the New Year.