Pain and HIV care

HIV-positive people who are experiencing pain are more likely to miss clinic appointments, US research shows.

Pain is common among people with HIV. Doctors in the US wanted to see what effect pain, mood problems such as anxiety and depression, and substance use had on clinic attendance.

They monitored 1500 people over a year.

Over a third of study participants reported pain at the start of the study. Results showed that the presence of pain reduced the likelihood of regular clinic attendance by 50%. But this was only the case for people who were not misusing drugs or alcohol.

“By affecting no-show visits, an important step in the HIV treatment cascade, pain has important implications for individual and public health outcomes,” comment the researchers.

The results underline the importance of taking pain seriously. Pain lasting for more than a few days should be reported to your HIV doctor or GP. The causes of pain should always be investigated. Specialist help, support and treatment are available if you are experiencing long-term pain.

Want to prepare for your next appointment? Use our free online tool, Talking points, to build a checklist of things to discuss with your doctor.

HIV and kidney disease

Starting HIV treatment reduces the risk of kidney disease, new research shows.

Kidney disease is an important cause of serious illness in people with HIV. Possible causes include risk factors such as diabetes; the damage caused by untreated HIV infection; and the side-effects of some anti-HIV drugs.

Researchers wanted to get a clearer understanding of the impact of starting HIV treatment on the risk of kidney disease.

They therefore monitored kidney function in over 3300 people between 1996 and 2009.

Kidney disease was less likely to develop in people who started HIV treatment than in those who did not. Good increases in CD4 cell count and an undetectable viral load were associated with an especially low risk of kidney disease.

However, the results also showed that people who took a combination of drugs including tenofovir (Viread, also in Truvada, Atripla and Eviplera) and ritonavir (Norvir) were more likely to develop kidney problems than people taking other antiretrovirals.

However, the association between these drugs and kidney dysfunction disappeared when the researchers used a more limited definition of kidney disease. Nor were the drugs associated with an increased risk of severe kidney disease.

The researchers stress that the risk of kidney disease associated with tenofovir and ritonavir was low. It was generally mild and occurred in only 6% of people during an average of four years of treatment.

For information resources, news stories and features on HIV and kidneys, visit our kidney problems topics page.

HIV treatment and the metabolism

Italian researchers have found evidence that treatment with certain combinations of anti-HIV drugs may affect the body’s ability to process sugars.

Their study involved people with a lot of experience of HIV treatment and who were in poor health.

Soon after effective HIV treatment became available, it became apparent that it could cause a range of metabolic problems.

There have been major improvements in HIV treatment and care since then. Doctors wanted to see what impact combinations of some newer anti-HIV drugs had on glucose metabolism.

This small study involved people with a lot of experience of HIV treatment, but whose treatment wasn’t suppressing their viral load.

They changed treatment to a new combination: either raltegravir (Isentress), etravirine (Intelence) plus maraviroc (Celsentri); or raltegravir, etravirine plus ritonavir-boosted darunavir (Prezista).

All the participants had normal glucose levels when they switched treatment. Taking the new combinations, they all experienced a drop in viral load to an undetectable level and increases in CD4 count.

However, 8% subsequently developed impaired glucose tolerance and 13% were diagnosed with diabetes.

Older age was the only known risk factor for both these outcomes.

The researchers noted that there was a relationship between increases in CD4 cell count and long-term changes in insulin levels. Increased waist circumference was also related to the development of insulin resistance.

They therefore speculate that worsening glucose metabolism “may be a consequence of both antiretroviral drugs and restoration of health”.

For information resources, news stories and features on diabetes, visit our diabetes topics page.

New drug shows promise

An experimental anti-HIV drug appears to be safe and effective.

The drug is currently called BMS-663068 and belongs to a class of antiretrovirals called attachment inhibitors. These drugs prevent HIV from attaching to CD4 cells.

The small study involved 48 people, all of whom had a viral load above 5000 copies/ml. They were randomised to take one of five doses of the drug, with or without a ritonavir booster.

The drug was provided as monotherapy (not in a combination with other drugs) for eight days.

All doses of the drug achieved good falls in viral load and caused only mild side-effects.

“These data, together with the favourable pharmacokinetic profile and generally good tolerability observed in this study, support the further clinical development of BMS-663068 in combination antiretroviral therapy. A phase IIb study of BMS-663068 in treatment-experienced subjects (NCT01384734) is currently ongoing,” write the researchers.

For an overview of currently available antiretrovirals, visit our website to read or download the Anti-HIV drugs booklet, or the antiretroviral drugs chart.