HIV treatment – when to start
A US study suggests that starting treatment soon after infection with HIV could have some advantages.
There’s currently a lot of debate about the best time to start HIV treatment. Current UK and European guidelines recommend that, in most cases, treatment should be started when your CD4 cell count is around 350.
Treatment for people recently infected with HIV who have a higher CD4 count is only recommended in certain circumstances.
One large randomised study showed that treating people who were recently infected had only modest long-term benefits.
However, the results of a small US study involving 130 people showed some advantages.
The people in the study had become infected with HIV within the previous six months and were in good health. They were randomised into two groups – one to take immediate therapy for 36 weeks and the other to wait until they met the criteria for therapy stipulated in guidelines.
Overall, 10% of people in the immediate-treatment group then met the criteria for starting HIV treatment at some point in the next two years. In comparison, 50% of people who had not taken treatment soon after infection met the criteria for starting HIV treatment during the same period.
The researchers believe their results support the early use of HIV treatment. The debate around this subject is likely to continue.
HIV prevention – updated UK PEP guidance
UK guidelines for the use of HIV post-exposure prophylaxis (PEP) have been updated.
They take account of new information about the impact of effective HIV treatment on the risk of transmission.
PEP is no longer recommended if an individual had unprotected vaginal sex or unprotected insertive anal sex with an HIV-positive partner who has an undetectable viral load.
However, the use of PEP is still recommended if an individual had unprotected receptive anal sex, even if their partner has an undetectable viral load.
HIV and TB
Worldwide, TB is the single biggest cause of illness and death in people with HIV.
It is curable with a type of antibiotic treatment. However, extra care is needed when treating HIV in people with TB.
Italian researchers looked at CD4 cell increases in people starting HIV treatment for the first time.
A small number (2%) also had TB.
They found that CD4 cell counts increased more slowly in people with TB than it did in people who did not have TB at the time they started HIV therapy.
This difference persisted for up to three years.
Infection with TB also meant that it took longer for treatment to suppress viral load to undetectable levels.
The researchers think that the poorer outcomes seen in people with TB could be because anti-TB and anti-HIV drugs can interact and have overlapping side-effects. This could make HIV treatment less potent or make it more difficult for people to take their treatment as prescribed.
People with HIV who have had TB and been successfully treated are as likely to benefit from HIV treatment as people who have never had the disease.
HIV treatment – outcomes
Ethnicity does not affect HIV treatment outcomes in UK gay men.
Gay men remain a major focus of the UK’s HIV epidemic. Previous research has shown that gay men in minority ethnic groups have higher rates of the infection compared to white gay men, and there’s some evidence that their experience of health care is also poorer.
Now researchers have found that black and minority ethnic gay men are less likely to engage with HIV care. They were also less likely to start HIV treatment compared to white gay men.
But the differences were small. Moreover, once treatment was started, ethnicity did not affect outcomes.
Nearly all HIV treatment and care in the UK is provided by the NHS on a free and equitable basis. For more information visit Access to health care.
HIV and hepatitis C – new protease inhibitors
They hope it will be useful for patients and doctors in other settings.
Current hepatitis C therapy for people with HIV consists of 48 weeks of therapy with pegylated interferon and ribavirin. This can cure hepatitis C, but it doesn’t always work.
In May 2011 the protease inhibitors boceprevir and telaprevir were approved in the US for the treatment of chronic hepatitis C genotype 1 infection. Clinical trials that led to approval involved people with hepatitis C mono-infection (e.g. they did not have HIV).
There is only very limited information on the safety and effectiveness of the drugs in people co-infected with hepatitis C and HIV. Studies that will provide some answers are currently underway.
However, liver disease caused by hepatitis C is a major cause of serious illness and death in co-infected people, so guidance of the best use of these new drugs is urgently needed.
Researchers looked at the published information about their use in co-infected people and developed recommendations. They stress that they should only be considered for people with genotype 1 infection. They have made detailed recommendations for the use of these drugs, including suitability criteria, duration of therapy, food restrictions and possible interactions.
New Year resolutions?
At this time of year many people decide to make changes to their lives.
You’ll find information to support you sustain a healthy life throughout 2012 and beyond here:
- Preparing for your next doctor’s appointment.
- Starting and sustaining an exercise programme.
- Stopping smoking.
- Diet and nutrition.
- Returning to work or study.
- Dealing with debt and money worries.
- Sign up to receive HIV treatment update.
And if you want to get involved with NAM and supporting us in continuing to produce evidence-based HIV information, you could:
- Make a regular donation by direct debit.
- Give us feedback on the information we produce.
- Run the London 10K for us.
- Share an experience with us.
- Make a one-off donation.
Contact us on 020 7837 6988 or info@nam.org.uk for more information on any of these things.