HIV and pregnancy – atazanavir dose
Revised guidance about the use of atazanavir (Reyataz) during pregnancy has been issued in the United States.
It is now recommended that the atazanavir dose of 300mg once daily must be taken with a 100mg ritonavir (Norvir) booster.
The revised guidance also says that women who have previous experience of HIV treatment, or who are also taking tenofovir (Viread, also in the combination pill Truvada) should take an increased dose of atazanavir (400mg with 100mg ritonavir, once daily) during the second and third trimesters of pregnancy.
In the European Union it is recommended that a 300mg dose of atazanavir should always be boosted with 100mg ritonavir for anyone taking the drug.
If blood levels of a drug are too low, viral load has an opportunity to increase. This can lead to the development of resistance, and for pregnant women it could possibly increase the risk of mother-to-child HIV transmission.
You can find out more about HIV treatment during pregnancy in the booklet HIV and women which has been jointly published by NAM and Positively UK.
HIV treatment – depression and substance use associated with intermittent treatment
The aim of HIV treatment is an undetectable viral load. The majority of patients taking anti-HIV drugs have a good chance of achieving this outcome.
However, viral load remains detectable or increases in some patients, and this has been associated with depression and drug use.
However, the research also showed that this was probably because those who used these drugs or who had depression were more likely to interrupt their HIV treatment.
But the researchers also note that poor self-care or sleep patterns that can accompany either depression or drug use may also have had a role.
They recommend that patients should be screened for depression and drug use during their routine HIV care.
Treatments for depression work well in people with HIV, and there’s a lot of support available for patients with this and other emotional and mental health difficulties.
HIV clinics should be non-judgemental about drug use and be able to offer appropriate support and referrals.
You can find out more about HIV and mental and emotional health in NAM’s booklet on this subject.
HIV and hepatitis C – transmissions due to sex and injecting drug use
There seems to be an increase in sexually transmitted hepatitis C among HIV-positive gay men in the UK and many other industrialised countries.
Research conducted in Australia provides some new insights into these infections.
It looked at the probable route of transmission of hepatitis C in 163 patients, 29% of whom were HIV-positive.
Drug use was responsible for 73% of infections.
There was some evidence of sexual transmission of the virus in HIV-negative heterosexual couples – in each case the person contracting the virus had a partner who was known to be infected with hepatitis C.
There was one possible case of sexual transmission of hepatitis C involving an HIV-negative gay man.
All the HIV-positive individuals infected with hepatitis C were gay men.
The investigators were able to link over half of the infections in HIV-positive gay men and found that there were “clusters” of infections.
This is consistent with what is already known about the epidemic – group sex with other HIV-positive men has been identified as a risk factor.
US researchers have also found evidence of sexually transmitted hepatitis C among men with HIV. They monitored rates of the infection between 1996 and 2008 in over 1800 individuals. There were only 36 new cases of HIV. But three-quarters seemed to be due to sexual transmission.
For more information sexual transmission of hepatitis C among HIV-positive gay men, you can read the feature ‘Staying free of hepatitis C’ on our website.
HPV vaccination
The Gardasil vaccine against strains of human papillomavirus (HPV), the virus associated with genital warts and with an increased risk of cervical, anal, penile and some head and neck cancers, is safe and effective in boys and young men.
The vaccine has already been shown to be effective in girls and young women, and it’s recommended that girls should receive it before they become sexually active.
Researchers wanted to see if the vaccine worked and was safe in boys and young men.
They therefore recruited over 4000 individuals in 18 countries. They were divided into two groups: one received the vaccine, the other a placebo.
All the individuals recruited to the study were sexually experienced, and 602 were gay or bisexual.
The vaccine was shown to be effective, especially among those who received all three doses of the vaccine.
Rates of side-effects were similarly rare in those who received the vaccine and those given the placebo.
Studies are underway looking at the effectiveness of the vaccine in people with HIV.