HIV treatment: 3TC vs FTC

An analysis of the results of twelve separate studies, involving approximately 5000 people, has shown the equivalence of the anti-HIV drugs 3TC (lamivudine, Epivir, also in Combivir) and FTC (emtricitabine, Emtriva, also in Truvada, Atripla and Eviplera).

Both 3TC and FTC are NRTIs (nucleoside reverse transcriptase inhibitors) and one or other of the drugs is used in most HIV treatment combinations.

The drugs have a similar chemical composition and are regarded as interchangeable in most treatment guidelines. But some studies have shown that people taking FTC are more likely to achieve and maintain an undetectable viral load than people treated with 3TC.

An international team of researchers wanted to see if this really was the case.

They therefore combined the results of all randomised studies comparing combinations that included 3TC or FTC. They only included studies that allowed a direct comparison between 3TC and FTC.

Overall, the chances of treatment success were identical for people taking either drug.

The rate of side-effects was also very similar.

The researchers therefore conclude there are no significant differences in outcomes between people treated with 3TC or FTC.

If you’re thinking about starting HIV treatment, you may find our online tool Get set for HIV treatment helpful: www.aidsmap.com/getset

HIV and faith

Church attendance is associated with late HIV diagnosis among men who have sex with men, new US research shows.

Faith is very important to many people with or at risk of HIV. Churches and other places of worship sometimes have HIV testing or outreach events and provide support to people living with HIV.

But this isn’t always the case. Religious belief can provide a basis for stigmatising attitudes towards sexual behaviour and some HIV risk groups, especially gay men and other men who have sex with men (MSM).

Researchers in Alabama in the southern United States wanted to see if church attendance was associated with HIV testing and the risk of late diagnosis.

They therefore asked 508 people newly diagnosed with HIV if they regularly attended church.

Church attendance was reported by 53% of men who have sex with men, 59% of men who have sex with women and 64% of women who have sex with men.

Overall, a third of people in the study had their HIV diagnosed late – defined in this case as being diagnosed when their CD4 cell count was below 200.

MSM who attended church were significantly more likely to be diagnosed late than MSM who did not attend church (32 vs 20%). This difference was statistically significant after taking into account other factors potentially associated with late diagnosis.

There was no association with church attendance and late diagnosis for other HIV risk groups.

The researchers also found some evidence that church attendance was associated with less frequent HIV testing among MSM. But for women who have sex with men, church attendance had a positive effect, increasing the likelihood of testing.

Three possible explanations are offered by the investigators for the association between church attendance and late diagnosis among MSM:

• Stigmatising attitudes towards MSM in some churches.
• Denial about HIV risk among church-attending MSM.
• Turning to organised religion for support due to illness caused by undiagnosed HIV.

Although the researchers acknowledge the positive role of churches in HIV outreach programmes, they also suggest that some churches may need to “explore reasons why their HIV-infected MSM members might present with more advanced disease than non-church-attending MSM.”

Harm reduction for people who inject drugs

New research provides convincing evidence that harm-reduction programmes are highly effective at preventing new HIV infections among people who inject drugs.

The study was conducted in Australia and found an extremely low rate of new HIV infections among people who inject drugs over a 20-year period.

Globally, people who inject drugs are one of the groups most affected by HIV. In some countries, almost three-quarters of this population have HIV.

But harm-reduction programmes that provide clean syringes and needles and education about safe injecting practices can help prevent HIV infections among people who inject drugs.

Free and legal needle exchange programmes were introduced in Australia early in the HIV epidemic. Research conducted in the early 1990s showed an extremely low rate of new HIV infections among people who injected drugs. Investigators wanted to see if this success had been sustained.

They therefore analysed HIV test results obtained from approximately 32,000 people who inject drugs and who had repeat HIV tests while accessing needle exchange programmes between 1995 and 2012.

All the participants were HIV negative at baseline. Only 17 acquired HIV, an overall incidence rate of 0.11%.

The majority of infections involved gay men, but even in this group incidence was low (0.83%).

The researchers therefore conclude that harm-reduction programmes for people who inject drugs are successful at preventing new HIV infections.