Long-term effectiveness of single-tablet regimens

The newest once-daily, all-in-one HIV combination pills can maintain undetectable viral load for two years and counting, according to a set of recent studies.

Biktarvy is a pill that contains the new integrase inhibitor bictegravir, emtricitabine and tenofovir alafenamide (TAF). A study randomised people starting treatment for the first time to take Biktarvy or Triumeq, which consists of the integrase inhibitor dolutegravir plus abacavir and lamivudine.

After two years, 88% of Biktarvy recipients and 90% of Triumeq recipients had an undetectable viral load, showing that the two pills gave very similar results. Virological failure and drug resistance were rare in both groups of people. Fewer people receiving Biktarvy had side-effects from their treatment.

Delstrigo is a pill that containes the new non-nucleoside reverse transcriptase inhibitor (NNRTI) doravirine plus tenofovir disoproxil fumarate (TDF) and lamivudine. A study randomised people starting treatment for the first time to take Delstrigo or Atripla, which contains the NNRTI efavirenz, TDF and emtricitabine.

After two years, 78% of people given Delstrigo and 74% given Atripla had an undetectable viral load, again showing that the two pills gave very similar results. Virological failure was uncommon and drug resistance was rare in both groups of people. Fewer people receiving Delstrigo had side-effects from their treatment.

Whereas the last two studies were of people taking HIV treatment for the first time, the third one was of people switching from a protease inhibitor-based treatment (with several pills) to Symtuza, a single tablet that contains the protease inhibitor darunavir, cobicistat as a booster, TAF and emtricitabine.

After two years, 91% of those given Symtuza had an undetectable viral load. Virological failure, drug resistance and serious side-effects were rare.

Taken together, the results of these studies provide reassurance that people taking the most recently approved all-in-one antiretroviral regimens can expect ongoing viral suppression, with few side-effects.

First HIV-positive to HIV-negative liver transplant

An HIV-negative child has received a liver transplant from their HIV-positive mother and now appears to have no evidence of HIV infection apart from a very weak antibody response, despite extensive testing for the virus, South African scientists report.

The baby needed the transplant because of end-stage liver disease. When a donor could not be found, the mother asked to donate a portion of her own liver. The procedure had never been attempted from a living HIV-positive donor before, both because of the risk of HIV transmission and because of concerns for the donor’s own health, in the case of complications.

The transplant happened when the baby was 13 months old. The mother had an undetectable viral load and the infant took a large number of drugs, including steroids to prevent organ rejection and antiretrovirals to prevent HIV acquisition.

Several weeks after the transplant, the baby tested positive for HIV antibodies, but levels of these rapidly declined to almost undetectable levels, indicating a lack of HIV replication to stimulate antibody responses. No HIV DNA or RNA has ever been detected.

The researchers cannot decide whether the child has cleared HIV or if the virus is deeply hidden, perhaps only in the liver. The only way to find out would be to stop the anti-HIV drugs the child is taking and monitor for a rebound in viral load.

The ethical implications of doing so need to be fully thought through. And experts say that this one case does not yet demonstrate that organ transplants can be safely given from HIV-positive donors, without HIV infection taking hold. But the case has generated interesting new data for cure researchers to analyse.

Pain

Pain is very common among people living with HIV and has a major impact on quality of life, British researchers report. They compared pain in three groups:

• Older people living with HIV, over the age of 50
• Younger people living with HIV, under the age of 50
• Older people who don’t have HIV but are otherwise very similar to the older people living with HIV.

Participants were asked if they currently had aches or pains that had lasted a day or more. Current pain was common in all participants, but was more frequently reported by older people living with HIV (49%) than younger people living with HIV (38%) or older HIV-negative people (40%). People experiencing pain were more likely to be female, heterosexual and of Black African ethnicity.

People with current pain reported poorer quality of life than other people. Of those in pain, 14% had taken days off work, 30% were unemployed or on sick leave (twice the rate seen in people who were not currently in pain) and, in the older age group, 60% reported depression.

The researchers say that doctors need to do more to encourage their patients to talk about pain. Doctors should provide more help to ease pain and to help people deal with it.

For more information, read NAM’s factsheet ‘Pain’.

Quitting smoking

An intervention that helped smokers give up cigarettes at the same time as helping with anxiety and depression proved to be more effective than an intervention that only helped with smoking, American researchers have found.

Anxiety and depression are more common among smokers than non-smokers. Anxiety and depression often contribute to failed attempts at giving up smoking, so researchers tried an integrated approach using a cognitive behavioural therapy approach.

Six months after the end of the programme, 46% of people who received the integrated intervention were not smoking, compared to 5% of people getting a standard smoking cessation intervention.

For more information, read NAM’s factsheet ‘Smoking’.