HIV treatment – changing because of side-effects

Switching from efavirenz to raltegravir leads to improvements in mood and lipid levels, new research shows.

Efavirenz (Sustiva, also in the combination pill Atripla) is a widely used anti-HIV drug that belongs to the non-nucleoside reverse transcriptase inhibitor (NNRTI) class of antiretrovirals.

It has a powerful and long-lasting anti-HIV effect, and is generally easy to take.

Like all medicines it can cause side-effects, in particular mood and sleep problems. These are most noticeable in the first few weeks of treatment and then tend to lessen or go away. But for a small number of patients they remain a subtle, long-term side-effect. In addition, the drug has been associated with increases in cholesterol, which can increase the long-term risk of cardiovascular disease.

Raltegravir (Isentress) is a relatively new anti-HIV drug, taken twice a day, that prevents the virus from integrating with human cells. It’s the first in a class of anti-HIV drugs called integrase inhibitors.

Researchers in Switzerland wanted to see if switching from efavirenz to raltegravir was associated with a reduction in side-effects such as mood and sleep problems, as well as lipid levels.

They therefore designed a four-week study involving 57 patients taking long-term efavirenz treatment.  

The patients were divided into two groups – one group changed to raltegravir, and the other continued to take efavirenz. After two weeks, each group switched to the other drug.

At the start of the study, and then after two and four weeks, the patients completed questionnaires enquiring about their mood and sleep. Blood samples were also taken to monitor lipids.

Their answers showed that patients preferred treatment with raltegravir, and over half switched to this drug at the end of the study.

Treatment with raltegravir was associated with improvements in mood, and cholesterol fell when patients were taking this drug.

“Switching to raltegravir was associated with significant improvements in anxiety and stress…and improvement in lipid profile,” conclude the authors.

You can find out more about dealing with side-effects in NAM’s booklet Side-effects. It is available on our website in English, Dutch, French, German, Hebrew, Norwegian, Polish, Russian, Spanish and Swedish.

HIV and hepatitis – treatment for hepatitis C

Acute hepatitis C infection can be successfully treated in patients with HIV with 24 weeks of therapy, new research shows.

Many people with HIV also have the hepatitis C virus (this is often called 'co-infection'), a condition which can cause inflammation of the liver. Routine HIV care should involve monitoring of liver function, and people at risk of contracting hepatitis C should be tested for the virus at regular intervals. This means it’s possible to detect infections early.

This is very important as treatment for hepatitis C works best if it’s provided soon after someone is infected with the virus.

This treatment normally lasts 48 weeks and consists of two drugs – pegylated interferon and ribavirin.

It can cause unpleasant side-effects, so researchers in Spain wanted to see if the duration of therapy could be shortened to 24 weeks.

Their study sample included 50 HIV-positive gay men with recent hepatitis C infection.

One group of patients (58%) received 48 weeks of treatment, and the remaining people were treated for 24 weeks.

Responses were monitored at several timepoints, and patients were considered cured if they had an undetectable hepatitis C viral load six months after the completion of therapy (a ‘sustained virological response’).

Overall, 76% of patients had a sustained virological response.

Patients who received 48 weeks of treatment were twice as likely to have a sustained virological response.

But this result could just have been chance as the difference didn’t meet what’s called 'statistical significance'.

“The shorter regimen would be of great advantage for patients, since both peginterferon and ribavirin can cause serious side-effects,” suggest the researchers.

However, their sample size was small, so they call for further research.

Browse resources, features and news on our hepatitis C topic page.

HIV and hepatitis – hepatitis A vaccination

People with HIV have a good long-term response to the hepatitis A vaccine, US research shows.

Hepatitis A can cause a short-term illness involving very unpleasant symptoms. It is recommended that all HIV-positive people should be vaccinated against the infection.

Researchers from the US military wanted to see how effective the vaccine was in the long term.

They monitored 130 people who were vaccinated between 1996 and 2003.

One year after vaccination, 89% of patients were protected against hepatitis A.

Six to ten years later, 85% of these individuals still had adequate levels of antibodies to protect them against the infection.

A low HIV viral load was associated with a better long-term response to the vaccine

But responses in people with HIV were poorer than those seen in the general population.

Hepatitis A vaccination is available for free from your HIV clinic. Your care should include tests to monitor how effective the vaccine is and, if necessary, a booster dose can be provided.

You can find out more about hepatitis in NAM’s patient information booklet ‘HIV & hepatitis’. It can be read online, downloaded as a PDF or viewed as a ‘flipbook’ online.