HIV Weekly - 8th May 2013

Gay men and access to HIV services

A large worldwide study has shown that homophobia, stigma and violence often prevent gay men from accessing HIV prevention and treatment services.

The study was conducted between April and August 2012 and involved over 4000 men who completed an internet-based questionnaire.

Most of the men (84%) described themselves as gay, and the majority (75%) came from high-income countries. Eighteen percent reported that they were HIV positive.

The survey enquired about access to condoms, lubricants, HIV testing and antiretroviral treatment.

Overall, only around a third of the men had easy access to condoms, lubricants and testing. Half of HIV-positive men in richer countries and 7% of those in poorer settings reported easy availability of antiretroviral therapy.

Younger gay men were especially likely to report difficulties obtaining HIV prevention or treatment services.

Gay men who reported homophobia or stigma were especially likely to report difficulty accessing both HIV prevention and antiretroviral therapy.

But involvement in either a gay community organisation or HIV support group were both associated with an increased likelihood of access of services.

There’s lots of useful information on dealing with HIV-related stigma in our booklet HIV, stigma & discrimination (www.aidsmap.com/stigma). Our e-atlas (www.aidsmap.com/e-atlas) provides a comprehensive listing of HIV-related services around the world, containing information on over 2500 key service providers in 189 countries.  

Access to new hepatitis C protease inhibitors in Europe

There’s an urgent need for new anti-hepatitis C drugs to be made available to patients with liver cirrhosis on a compassionate basis, delegates at the recent International Liver Congress (EASL 2013) were told.

Two hepatitis C virus (HCV) protease inhibitors – boceprevir (Victrelis) and telaprevir (Incivo) – were recently approved for the treatment of people with hepatitis C genotype 1. A number of other anti-hepatitis C drugs are currently in development.

However, access to these drugs is currently very limited for many people in urgent need of new treatment options, including those with decompensated cirrhosis. Untreated hepatitis C damages liver cells and can lead to the liver becoming scarred. When this is severe, it is known as cirrhosis. The liver can initially continue to function (‘compensated cirrhosis’) but eventually liver function is restricted (‘decompensated cirrhosis’).

Delegates to EASL 2013 discussed the pros and cons of making treatments available through compassionate access schemes.

Compassionate access can make medicines available to people with an unmet medical need, prior to the formal approval of a drug. It usually takes the following forms:

• Individual named-patient access in urgent cases.
• A cohort study with eligibility criteria, which collects information on the safety and effectiveness of the drug and is run through specialist treatment centres.
• An 'expanded access' scheme, providing the drug to large numbers of patients, even before its formal approval and without the collection of information on effectiveness.

Over 600 patients in France with cirrhosis have already received therapy with boceprevir and telaprevir thanks to a compassionate access programme.

In some European countries, compassionate access is the only way of obtaining therapy with new anti-HCV drugs.

Drug companies are in negotiation with treatment advocacy and patient groups about making new agents available to individuals with advanced cirrhosis and those awaiting liver transplant.

However, concerns about side-effects and other toxicities could prove to be a barrier.

For instance, there’s been a very high incidence of serious adverse events and a low treatment response rate among French patients with cirrhosis provided with compassionate access to the two new protease inhibitors.

There were clear differences of opinions between doctors and patients about who should make the final judgement about the potential risks and benefits of a treatment.

Some doctors said they welcomed compassionate access schemes, but only when the risk-to-benefit ratio was favourable. On the other hand, many patients said they should be able to make an informed choice about their individual suitability for experimental treatment.

For information on HIV and hepatitis co-infection, you may find our HIV & hepatitis booklet helpful. Visit www.aidsmap.com/booklets.

Oral HCV treatment regimen does well in clinical trial

A combination of three experimental oral anti-HCV drugs has achieved very high treatment response rates in a clinical trial.

People with hepatitis C genotype 1 were treated with daclatasvir, asunaprevir and BMS-791325.

There drugs all work directly against HCV and are called ‘direct-acting antivirals’ or DAAs.

The use of a triple combination of DAAs meant that patients did not require therapy with pegylated interferon and ribavirin. These two drugs currently form the basis of HCV therapy but can cause unpleasant side-effects and don’t always work.

The present study involved 66 people taking HCV therapy for the first time. None had liver cirrhosis.

The study participants were divided into four groups and received different doses of the study drugs for twelve or 24 weeks.

Between 89 and 94% of participants had an undetectable HCV viral load four weeks after completing therapy.

The most common side-effects were nausea, vomiting and diarrhoea. There were no serious adverse events related to the study medication.

For more news from the International Liver Congress, visit our conference pages: www.aidsmap.com/conferences