Viral load in semen after stopping treatment

Viral load rebounds rapidly in semen to infectious levels following interruption of HIV treatment, a new study shows.

Ten men were taking part in a study of a potential therapeutic vaccine. They all had an undetectable viral load in both blood and semen when they stopped taking their HIV treatment. For the next 12 weeks, they provided blood and semen samples every two weeks, before re-starting their HIV treatment.

Two weeks after stopping treatment, viral load had rebounded to detectable levels in the semen of four men. Four weeks after stopping treatment, it had rebounded in the semen of another four participants. The semen samples were missing for the last two participants.

These levels were infectious (average 40,000 copies/ml). In fact, an HIV transmission occurred from a study participant to his partner during the treatment interruption phase of the trial.

The findings have clear implications for HIV treatment as prevention, showing that viral load in semen can increase rapidly to infectious levels during a break in treatment.

For more information, read NAM’s factsheet ‘Viral load and transmission – a factsheet for people with HIV’.

How would you like to take your treatment?

Researchers are interested in developing forms of HIV treatment that don’t have to be taken so often. Injectable treatment that is taken once a month might be available in the next few years and other options are being worked on.

But there hasn’t been much research with people living with HIV, to ask what they’d like. A small study, done with 263 people living in North and South Carolina, has recently been published. The participants had been taking treatment for an average of 12 years, half were men, and 80% were from a racial or ethnic minority. 

Participants were asked how interested they would be in switching to:

• a single pill once a week: 66% were very interested.
• two injections in the clinic every other month: 39% were very interested.
• a small plastic rod that could be implanted (and removed) from the forearm, every six months: 18% were very interested.

The researchers point out that there is no one method which appealed to everybody. People have a range of views about different options.

Two-drug protease inhibitor regimens

Another area of research is into HIV treatment regimens that involve fewer drugs. In the last few years several studies have compared treatment with two-drug regimens with three-drug regimens, each based on boosted protease inhibitors. For example, a two-drug regimen could be darunavir (boosted with ritonavir) taken with lamivudine. A three-drug regimen would also include another drug, such as abacavir.

Pooling the results of seven small studies, researchers found that the two-drug regimens were just as effective. In addition, people taking the two-drug regimens were less likely to need to change treatment because of side-effects. The results were equally applicable for people taking treatment for the first time and for people switching treatment.

New drugs for people with a lot of drug resistance

A recent conference heard about treatment options for people whose HIV has resistance to most other anti-HIV drugs.

Ibalizumab (Trogarzo) is a monoclonal antibody that attaches to the CCR5 or CXCR4 co-receptors on cells and so stops HIV from infecting them. It is taken as an infusion (drip) every two weeks, in additional to conventional HIV treatment. The 40 people who took part in a recent study had very advanced HIV disease (median CD4 cell count 73 cells/mm³), 90% had resistance to drugs in at least three drug classes, and they had been living with HIV for a median of 23 years. 

After 48 weeks, 15 of 40 people who started treatment with ibalizumab had a viral load below 50 copies/ml. Ibalizumab is available in the US and is being reviewed by European regulators.

Fostemsavir, another drug for the treatment of drug-resistant HIV, prevents HIV from attaching to CD4 cells by sticking to the virus, not the cell. It prevents a change of shape of HIV’s gp120 protein that is necessary for it to lock on to the CD4 receptor. As in the other study, the 371 people who took part in the study had few treatment options left – their average viral load was around 40,000 copies/ml and three-quarters had a CD4 count below 200.

They took fostemsavir alongside other antiretroviral drugs. After 48 weeks, 54% of people who were still able to use one or two other HIV drugs had an undetectable viral load. Of individuals who could not have any effect from other HIV drugs because of resistance, 38% had an undetectable viral load. Fostemsavir is not yet licensed.

Getting help with depression and giving up smoking

An internet-based programme is effective for the treatment of mild to moderate depression in people with HIV, according to a Dutch study.

The online programme was based on principles of cognitive behavioural therapy. It was developed specifically for people with HIV and encouraged participants to engage in pleasant activities, use relaxation techniques, challenge negative thoughts, and set realistic, concrete goals. As well as working through online modules for an hour or two a week, participants got some telephone support.

People who were randomly assigned to the online programme had a greater improvement in their symptoms of depression than people in the control group. Anxiety symptoms were also decreased.

Separately, American researchers wanted to find a more effective way to help HIV-positive smokers give up. They had noticed that anxiety and depression are common among smokers, and often contribute to failed attempts at smoking cessation.

They offered weekly sessions based on cognitive behavioural therapy that dealt with smoking cessation, anxiety and depression together, as well as nicotine replacement therapy. Six months later, far more people who received the programme were still not smoking (46%) than was the case for people in the control group (5%).

For more information, read ‘Depression’ in NAM’s booklet ‘HIV, mental health & emotional wellbeing’, and NAM’s factsheet ‘Smoking’.

Hepatitis C in rectal and nasal fluids

High levels of hepatitis C virus can be found in the rectal and nasal fluids of people with high hepatitis C viral loads even when blood is not present, a new study shows.

The findings reinforce the plausibility of hepatitis C transmission through sharing of rolled-up bank notes to snort drugs. They also support the hypothesis that hepatitis C can be passed on during anal sex, regardless of whether there is any bleeding. A previous study showed that the virus can be found in semen.

For more information, read NAM’s illustrated leaflet ‘How hepatitis C is passed on during sex’.

Gammora does not cure HIV

You may have read news headlines suggesting that a new drug called Gammora “kills 99.9% of HIV” and “could offer a cure”.

Unfortunately, this is not true. The study has not been presented at a scientific conference or published in a peer-reviewed medical journal. The only available information is a badly written press release, which announces results that are no better than conventional antiretroviral therapy. What’s more, the nine patients who took Gammora were also taking conventional antiretroviral therapy.

“The HIV world has seen quackery in different forms for decades – sadly this smacks of more of it,” Professor Francois Venter of the University of Witwatersrand, South Africa commented. “This gives science and scientists a bad name.”

For more information, read NAM’s leaflet ‘Myths and facts’.