HIV and pregnancy
The anti-HIV drug raltegravir (Isentress) is safe and effective during pregnancy, new research shows.
Raltegravir belongs to a class of antiretrovirals called integrase inhibitors. It’s an important treatment option for people taking HIV therapy for the first time and also for people who are changing their treatment.
Doctors wanted to see if use of the drug during pregnancy was safe and effective.
Raltegravir can reduce virus levels more quickly than other drugs and so it may be a useful option for women who start treatment during pregnancy. Suppressing viral load as early as possible before giving birth improves the chances of an HIV-free baby.
They therefore looked at outcomes in 31 women living with HIV who were treated with the drug during pregnancy after 2008. Raltegravir was used in combination with other anti-HIV drugs.
Raltegravir was safe and well-tolerated. The drug had the same potent anti-HIV effect seen in other patients with HIV.
At the time of delivery, 81% of women had an undetectable viral load.
Approximately two-thirds of women had a caesarean section, half of which were planned.
There were 32 live births. In all cases, birth weight and size at birth were within normal ranges. None of the infants had birth abnormalities.
The infants receive prophylactic treatment with AZT (zidovudine, Retrovir). After six months, 93% had undetectable HIV DNA.
The children included in this study will be followed for up to six years. This will enable researchers to assess the long-term safety of exposure to raltegravir during pregnancy.
For more information you may find our online HIV & pregnancy tool useful: www.aidsmap.com/pregnancy
Changing treatment – Atripla to Eviplera
Atripla is a once-daily treatment for HIV that combines three drugs into one pill. It is widely used in first-line HIV treatment. However, efavirenz can cause CNS side-effects including insomnia, vivid dreams, depression and anxiety.
Researchers wanted to see if these side-effects were alleviated by switching to Eviplera, which similarly combines multi-drug HIV therapy into a single pill taken once daily.
The study population comprised 40 people taking Atripla. All had an undetectable viral load.
The study participants were asked to score their CNS side-effects at the start of the study, before they switched drugs. There were significant improvements in CNS side-effects four weeks after changing therapy, and at week 20 scores were still significantly lower compared to baseline. There were also improvements in blood lipids.
All the study participants maintained an undetectable viral load.
Separate research showed that Eviplera was a safe and effective treatment option for women and was associated with fewer CNS side-effects than Atripla.
Eviplera was also shown to be non-inferior to first- or second-line HIV therapy based on a boosted protease inhibitor.
Thinking about talking to your doctor about the treatment you’re taking? Our online tool, Talking points, is designed to help you prepare for that conversation: www.aidsmap.com/talking-points
HIV treatment as prevention
Researchers in the UK recruited 45 people living with HIV to take part in focus groups. Concerns about the cost of HIV treatment as prevention and the economic austerity policies being pursued by the current government were raised by some participants.
Other research involving 44 black African people living with HIV in England found that there was limited confidence in the use of HIV treatment as prevention. Some participants did not believe that there was proof that treatment worked as prevention, and some women thought it would undermine their ability to negotiate condom use.
A separate study involving healthcare workers in the UK and Australia showed that there was professional ambivalence to the use of HIV treatment as prevention. Some doctors thought that information about the impact of treatment on prevention diverted from a simple, clear message about the importance of condom use to prevent the transmission of HIV.
Another study showed that only a third of HIV specialist nurses felt confident discussing treatment as prevention with people in their care.
One of the leaflets in our illustrated series ‘The basics’ covers transmission and viral load. The leaflets in this series are designed to support conversations between healthcare professionals and people living with HIV and are available for HIV clinics and organisations in the UK to order. They can also be read online and downloaded from our website: www.aidsmap.com/thebasics. For more information, including information resources and an archive of news coverage, visit our Infectiousness and treatment as prevention topics page.
HIV and mental health
Depression is very common in people living with HIV. Doctors in the US wanted to see if it was related to the presence of HIV in CSF. Their research involved approximately 800 people, half of whom had a history of depression.
At the start of the study, 18% of participants in the study had detectable virus in their CSF despite having undetectable viral load in their blood. People with detectable virus in their CSF were approximately twice as likely to have depression.
The participants were monitored for 18 months. During this time depression was more common among people with detectable virus in their CSF.
Periods of detectable virus may give rise to drug resistance in the cerebrospinal fluid.
The researchers say that identifying and treating depression in people living with HIV may reduce the risk of detectable HIV in the cerebrospinal fluid and brain.
For more information on mental health, you may find our booklet HIV, mental health and emotional wellbeing useful. Copies of this booklet are available in HIV clinics and organisations throughout the UK. You can find all our booklets online at www.aidsmap.com/booklets
Editors' picks from other sources
Activists applaud UK Government for new contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria
from Results UK
The new pledge announced today by the UK Department for International Development (DFID) of up to £1 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is enthusiastically welcomed by activists who have been calling on the UK Government to increase its commitment.
UNAIDS reports a 52% reduction in new HIV infections among children and a combined 33% reduction among adults and children since 2001
from UNAIDS
New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33% reduction since 2001. New HIV infections among children have been reduced to 260,000 in 2012, a reduction of 52% since 2001. AIDS-related deaths have also dropped by 30% since the peak in 2005 as access to antiretroviral treatment expands.
Becoming a Healthwatch trustee and coming out in my neigbourhood
from Speaking Up! (blog)
I have spoken in front of thousands of people about living with HIV, however rarely was I so nervous as last night, when I had to speak in front of quite a number of Lambeth residents explaining why I wanted a seat on the board of my local Healthwatch. Healthwatch are local organisations that champion patients’ rights in the new NHS.
Tearful porn actress speaks out about HIV risk in adult film industry
from Los Angeles Times
Several current and former adult film performers who have tested positive for HIV spoke out on Wednesday about working conditions in the industry.