Treatment-experienced patients now have option of once-daily Kaletra
Kaletra has been approved for once-daily use by treatment-experienced patients in the US. The dose is 800mg lopinavir with 200mg ritonavir. The drugs are combined together in tablets, or for some patients an oral solution.
However, once-daily dosing of the drug is restricted to those with three or fewer mutations that confer resistance to the drug.
A clinical trial showed that treatment with the drug was equally effective and safe for treatment-experienced patients whether taken once or twice daily.
People starting treatment for the first time already have the option of taking Kaletra once a day. However, once-daily treatment with Kaletra is not recommended for children.
For more information on individual antiretroviral drugs, including information on side-effects and drug interactions, you may find our information booklet Anti-HIV Drugs useful.Diseases of ageing and lifestyle factors causing illness and death in people with HIV
AIDS remained the single biggest cause of death amongst the 39,000 patients in the study. These patients were monitored over a ten-year period. About two-thirds took HIV treatment. The overall mortality rate was 5%.
But mortality rates fell significantly after the introduction of effective HIV treatment. Subsequent improvements in HIV treatment and care achieved even bigger falls in AIDS-related deaths.
However, cardiovascular disease, liver disease and non-AIDS-defining cancers emerged as increasingly important causes of death.
A low CD4 cell count and a high viral load were associated with an increased risk of death from many of these non-HIV-related illnesses.
Older age increased the risk of death from causes such as heart attack, stroke and kidney disease.
Taking HIV treatment reduced the risk of death from both HIV-related and non-HIV-related causes.
But to achieve even bigger falls in mortality, it will be necessary to address lifestyle factors and health issues associated with ageing, suggest the researchers.
Eating a good diet, exercising and not smoking are all important to good health. Your routine HIV care should involve regular monitoring so that heart, kidney or liver disease can be spotted early, meaning that treatment can be provided.
The January/February edition of HIV Treatment Update included feature articles on healthy lifestyle issues, including giving up smoking and taking up exercise.
Heart disease
In separate research, French doctors have found that patients with HIV have an increased risk of heart attack.
They compared the rate of heart attack seen in 75,000 patients with HIV to that recorded in the general French population.
Their results showed that men with HIV with 50% were more likely to have a heart attack than HIV-negative men. The risk was even higher for HIV-positive women – they were 170% more likely to have a heart attack than HIV-negative women of the same age.
The researchers think that HIV itself is increasing the risk of heart attack.
Taking HIV treatment reduces the risk of HIV-related and some serious non-HIV-related illnesses as well, including heart disease.
Living with HIV in older age
An idea of what it’s like living with HIV in older age was provided by research conducted in Brighton. A total of 20 patients aged over 50 were interviewed about their experiences.
A common theme was a concern about the long-term effectiveness of HIV treatment, and the impact of other health problems.
Many of the participants reported problems with self-esteem and feeling excluded.
If you’re finding it difficult to cope, then your HIV clinic will be able to help. A lot of support is available for people with HIV, including mental health support and peer support, often provided through local voluntary organisations.
The Terrence Higgins Trust helpline, THT Direct, offers emotional support, as well as information on local organisations. You can contact them on 0845 12 21 200, or read more about them on the THT website.
HIV and drug use
Injecting and recreational drug use are both associated with an increased risk of health problems and other complications for patients with HIV.
Support is available for people who are concerned about their drug use. Two recently published studies have looked at the effectiveness of such support.
US research has shown that a combination of both counselling and drug treatment may be needed to reduce levels of opioid use in young people. Opioids include heroin and prescription painkillers.
LGV
There was a big increase in the number of LGV cases diagnosed in the UK in early 2010.
LGV (lymphogranuloma venereum) is a sexually transmitted infection. It’s caused by a strain of the chlamydia bacteria, but its symptoms are much more severe.
In the first quarter of this year, the number of LGV diagnoses was twice that recorded in the first three months of 2009.
Many of the diagnoses were in HIV-positive gay men, and the rectum was the most common site of the infection.
Unprotected sex, fisting, sex in saunas, group sex, and using methamphetamine were all identified by researchers as risk factors for the infection.
LGV can cause very unpleasant symptoms, but can be cured with a 21-day course of oral antibiotic treatment.
The most common symptoms of rectal infection are pain, a mucus discharge that is often bloody, swollen glands, and often a feeling of being generally unwell.