Omega 3 to lower triglycerides and inflammation

As people living with HIV get older, it makes sense to pay attention to heart health. Triglycerides and LDL cholesterol are two types of blood fats – raised levels are associated with an increased risk of heart disease.

A randomised study shows that people living with HIV who already have very high levels of triglycerides can reduce them with supplements of omega 3 fatty acids (extracted from fish oils). The supplement used was not one you can buy commercially but has a high dose and is only available on prescription (brand name Omacor in Europe and Lovaza in the United States).

People in the study took the supplement for two years, and also attempted to improve their diet and lose weight.

People taking omega 3 had significant reductions in triglycerides (but not in cholesterol).

They also had significantly lower levels of a biomarker of inflammation. In people living with HIV, the long-term activation of the immune system in response to HIV (chronic inflammation) may contribute to the earlier onset of heart disease and other illnesses.

New form of tenofovir has good results for people aged 50+

One of the most widely used anti-HIV drugs is tenofovir disoproxil fumarate (DF) – it is included in the tablets Viread, Truvada, Atripla, Eviplera and Stribild. Tenofovir DF is highly effective and generally safe and well-tolerated, but can cause kidney and bone problems for a few people.

Tenofovir alafenamide (AF) is a new form of the drug that is delivered more efficiently to cells. This means that a lower dose is needed, which lowers the risk of side-effects. This new form of the drug, tenofovir AF, is included in the tablets Descovy, Odefsey and Genvoya.

While cheaper, generic versions of tenofovir DF will be available soon, tenofovir AF is a new drug exclusive to the pharmaceutical company Gilead – it is more expensive.

Access to tablets containing tenofovir AF is most important for people who need to pay attention to their kidney or bone health. Such problems are more likely to occur as we get older.

A new analysis compares people continuing to take tablets containing tenofovir DF with people switched to tablets containing tenofovir AF. They were aged between 50 and 79 (average age 55) and most were men.

Both forms of the drug were as effective as each other in reducing HIV to undetectable levels. People taking the newer tenofovir AF had improved levels of protein in urine and glomerular filtration rate (both are measures of kidney function) as well as improved bone mineral density at the spine and hip.

For more information on this issue, see an article from the American website BETA: ‘Ask A Pharmacist: With a new tenofovir, should you switch to Descovy, Genvoya or Odefsey?’

Drugs for all hepatitis C genotypes

A hepatitis conference last week heard excellent results from several studies of drug combinations which can treat all genotypes of hepatitis C. Until now, the treatment of hepatitis C has varied according to which of the six genotypes a person has.

Each genotype reflects a different genetic composition of the virus. At the moment, genotype testing is essential before getting treatment. But treating the virus may become simpler to manage with ‘pangenotypic’ drugs which are able to treat hepatitis C of all genotypes.

A single-tablet combination of a protease inhibitor called glecapravir and a NS5A inhibitor called pibrentasvir cured at least 98% of people with hepatitis C who had genotypes 1, 2, 4, 5 or 6. The drugs were taken as once-daily tablets for 8 or 12 weeks.

The same tablet was also tested against genotype 3 (which is often harder to treat) in a smaller, earlier phase study. Some of the people taking part had cirrhosis while others had already tried treatment but it had not worked. Over 96% of people were cured, although some needed to take the tablets for 16 weeks.

Other studies tested a different tablet, which combined three drugs: the nucleotide polymerase inhibitor sofosbuvir, the NS5A inhibitor velpatasvir and the protease inhibitor voxilaprevir. In people of all genotypes who had never taken treatment, it cured 95% of people after 8 weeks. In people who had previously tried treatment but it had not worked, it cured over 96% of people after 12 weeks.

For more information on hepatitis, read NAM’s booklet ‘HIV & hepatitis’.