HIV Weekly - 26th September 2012

Adherence – taking your HIV treatment

An international study has shown that levels of adherence to HIV treatment during pregnancy and after giving birth are often lower than recommended.

Adherence – taking HIV treatment at the right time and in the right way – is key to the success of HIV treatment. The goal of antiretroviral therapy is an undetectable viral load. Taking all, or nearly all, the doses of your treatment correctly gives you the best chance of achieving this outcome.

But many people find it hard to achieve such high levels of adherence. Lower levels of adherence means that viral load can increase and this can also lead to the development of drug resistance.

Treatment with antiretrovirals during pregnancy significantly reduces the risk of transmission of HIV to the baby. Researchers looked at the results of 51 studies, involving over 20,000 women, to see if pregnant women with HIV were achieving the levels of adherence needed to suppress their viral load.

Overall, only 76% of women had adequate levels of adherence during pregnancy (defined as taking between 80 and 100% of doses) and this fell to 53% after giving birth.

The authors suggest various explanations for difficulties taking HIV treatment during pregnancy and after giving birth, including economic and emotional stresses, depression (especially after giving birth), alcohol or drug use, and problems with the number or pills and how frequently they had to be taken.

The authors highlight nausea and vomiting in early pregnancy (‘morning sickness’) as a common problem, affecting over 70% of women. The authors also suggest that better adherence during pregnancy than after delivery may be due to the mother’s desire to protect the health of her unborn baby.

Strong social support was linked to high levels of adherence.

If you’re having problems taking your HIV treatment then it’s important to ask for help. To prepare for a conversation about treatment before your next appointment, try out our Talking Points tool at www.aidsmap.com/talking-points

Primary HIV infection

Sexual health and HIV clinics often don’t identify people newly diagnosed with HIV as being in the phase of primary HIV infection, new UK research shows.

The first few weeks after HIV infection has taken place are called primary HIV infection. It can involve symptoms such as fever, sore throat, rash and headache. It’s easy to mistake these symptoms as flu or a bad cold and they usually go away after a week or so.

People with primary HIV infection have a very high viral load and therefore the risk of HIV being passed on is higher during this phase. A large number of onward HIV transmissions originate in people who’ve only recently been infected with HIV themselves.

It’s therefore important to identify people with primary HIV infection. This means they can be advised about their potential infectiousness at this time. If appropriate, people may also be prescribed antiretroviral therapy to reduce their infectiousness.

Researchers in three HIV clinics in Brighton and London have found that only 48% of people with primary infection were correctly identified.

Their research involved 311 people who had been recently diagnosed with HIV.

Primary infection was more likely to be identified in gay and bisexual men, people with symptoms, people who had had an HIV test in the previous six months and people reporting recent unprotected anal sex.

Three-quarters of people with primary infection (recognised and unrecognised) received safer-sex counselling, and only a third were informed that people with primary infection are potentially very infections.

For more information on primary HIV infection, you may find our illustrated leaflet Very recent infection helpful. You can find out more about how we developed it in the NAM blog.

HIV and hepatitis B

The inclusion of tenofovir (Viread, also in Truvada, Atripla and Eviplera) in HIV therapy suppresses hepatitis B in people with HIV and hepatitis B co-infection whose hepatitis B is resistant to 3TC (lamivudine, Epivir), researchers have reported.

HIV and hepatitis B are transmitted in similar ways; therefore many people have both viruses (known as co-infection).

Several anti-HIV drugs also work against hepatitis B. These include 3TC, FTC and tenofovir. Antiretroviral therapy for people with co-infection should include drugs which work against both viruses.

Hepatitis B can become resistant to the drugs used to treat it. Resistance to 3TC – the first drug to be prescribed for people with co-infection – is especially common.

Researchers wanted to see if introducing tenofovir into HIV treatment combinations had a beneficial effect on drug-resistant hepatitis B.

They monitored hepatitis B viral load in 30 people who replaced either AZT (zidovudine, Retrovir) or abacavir (Ziagen, also in Kivexa) with tenofovir. There were big falls in hepatitis B viral load and 87% of people in the study had undetectable levels of hepatitis B DNA after 48 weeks.

However, only 9% of people cleared the infection.

Sometimes when people start taking treatment, there can be a short-term flare-up in liver inflammation. However, in this study, changing treatment was found to be safe and didn’t lead to flare-ups.

For more information on HIV and hepatitis co-infection, you may find our HIV & hepatitis booklet helpful.