Preventing hepatitis B

Including 3TC (lamivudine, Epivir, also in the combination pills Kivexa and Combivir) or tenofovir (Viread, also in the combination pills Truvada, Atripla and Eviplera) in antiretroviral treatment combinations reduces the risk of hepatitis B virus infection for unvaccinated gay men living with HIV, new research shows.

Hepatitis B and HIV are transmitted in similar ways, and many people have both viruses (co-infection).

A vaccine is available for hepatitis B. In the UK, all sexually active gay men are recommended to receive this vaccine, as are others at high risk of the infection, including injecting drug users and health workers.

In addition, all people living with HIV are recommended to be vaccinated against hepatitis B, unless they already have natural immunity.

But uptake of the vaccine is sometimes low.

The anti-HIV drugs 3TC, FTC and tenofovir are active against both HIV and hepatitis B. The recommended first-line antiretroviral combinations for people starting HIV treatment include at least one of these drugs.

Doctors in Japan wanted to see if HIV treatment combinations including either 3TC or tenofovir reduce the risk of new hepatitis B infections in gay men with HIV.

Their study sample included approximately 350 people who had not had the hepatitis B vaccination. They were categorised according to their use of HIV treatment: treatment including 3TC or tenofovir; treatment based on other drugs; no HIV treatment.

Overall, 43 people were newly infected with hepatitis B during the study. About two-thirds were people who weren’t taking any HIV treatment. There were six infections among people taking ‘other’ antiretroviral combinations, and seven people treated with 3TC were newly infected with hepatitis B.

Five of the participants taking 3TC were infected with a strain of hepatitis B that was resistant to that drug.

The researchers therefore believe that HIV treatment that incorporates either 3TC or tenofovir reduces the risk of hepatitis B infection for people who haven’t been vaccinated. However, the protective effect of 3TC is reduced if someone is exposed to drug-resistant hepatitis B.

In the UK, hepatitis B vaccination is available from sexual health and HIV clinics. It is provided over a course of three injections and it’s important to receive all three doses. Booster doses are sometimes necessary. 

There’s more information on hepatitis B in our HIV & hepatitis booklet.

Immune reconstitution inflammatory syndrome (IRIS)

About 14% of people with the AIDS-defining cancer Kaposi’s sarcoma (KS) experience a worsening of their condition after starting HIV treatment, new research shows.

This is thought to be due to immune reconstitution inflammatory syndrome (IRIS). If someone has a low CD4 count, their immune system may not be able to fight off infections. When HIV treatment is started and the immune system begins to strengthen, it may react by attacking any disease present in the body and this can cause new or increased symptoms temporarily for the person taking the treatment.

The research was conducted in sub-Saharan Africa and the UK.

A fifth of participants in the study in African countries developed KS-associated IRIS compared to 9% of study participants in the UK.

Risk factors included more advanced KS disease, a high HIV viral load and a high KS viral load.

After the development of the IRIS, 55% of participants were treated with HIV therapy and chemotherapy, the others with HIV therapy alone.

All the people in the UK had a complete or partial recovery compared to just 23% of those in Africa.

Experiencing IRIS was associated with an increased mortality risk, and this was highest for people who did not receive chemotherapy, as well those with a low CD4 cell count and a detectable KS viral load.

Our bulletin, HIV & AIDS treatment in practice (HATIP), is written for people working in HIV in resource-limited settings, including sub-Saharan Africa. For more information and to read the archive, visit www.aidsmap.com/hatip.

HIV treatment and ageing

Doctors in the UK have found that blood concentrations of protease inhibitors increase with age.

They are unsure of the significance of their findings, but hope their results “may assist in the design of future work assessing the effects of lifelong antiretroviral therapy in subjects ageing with HIV infection”.

Thanks to improvements in treatment and care, most people living with HIV in the UK can expect to live well into old age.

It’s already known that the way the body metabolises or processes medicines can change as we get older. But relatively little is known about the impact of ageing on blood concentrations of anti-HIV drugs.

Doctors in the UK therefore looked at blood samples obtained from 2447 people who had therapeutic drug monitoring as part of their routine HIV care.

Overall, 71% of patients were taking HIV treatment based on a drug from the protease inhibitor class, with the other 29% treated with a combination based on an NNRTI (non-nucleoside reverse transcriptase inhibitor).

Age didn’t have any impact on levels of NNRTIs in the blood.

However, concentrations of protease inhibitors increased significantly. The biggest increases were seen for ritonavir (Norvir) and saquinavir (Invirase).

Protease inhibitors are metabolised through the liver using an enzyme called P450. The researchers think this may be a reason for their findings.

There was no evidence that increased drug levels led to side-effects. Indeed, people were less likely to change their treatment as they aged.

For more information on different classes of anti-HIV drugs, start with our illustrated leaflet How treatment works, our booklet Anti-HIV drugs, or for more detailed information, take a look at HIV and its treatment.