HIV treatment – new drug approved in the US
Drug regulatory authorities in the US have approved a new anti-HIV drug.
Called rilpivirine (Edurant), it is a non-nucleoside reverse transcriptase inhibitor (NNRTI).
It has been approved for use in combination with other anti-HIV drugs by people starting HIV treatment for the first time.
Approval was based on the results of clinical trials comparing it to efavirenz (Sustiva), the NNRTI most commonly used by people starting HIV treatment.
The trial showed that overall rilpivirine was as effective as efavirenz. However, patients who had a high viral load – over 100,000 copies/ml – were less likely to achieve an undetectable viral load if they took Edurant than if they took efavirenz.
Rilpivirine appears to be a safe drug, and was less likely to cause the dizziness and rash that can sometime be associated with efavirenz.
The drug is taken once a day, with food.
European approval for rilpivirine is expected later this year.
There are plans to a manufacture a pill combining rilpivirine with tenofovir and FTC.
Experimental treatment – vaccine
An experimental vaccine may have cured monkeys of the HIV-like virus, SIV.
The vaccine didn’t protect the 24 monkeys in the study against becoming infected with SIV, but 13 of the rhesus macaques had SIV infection with an undetectable viral load.
The researchers commented that their vaccine seems to have produced “an unprecedented level of SIV control and even the possibility of progressive clearance of SIV infection over time”.
The exact significance – and safety of the vaccine used in the study – is being debated.
Hepatitis C treatment – new drugs
A new anti-hepatitis C drug has been approved in the US and an anti-hepatitis C drug already approved in the US has been recommended for approval in Europe.
Both the drugs are protease inhibitors and need to be taken in combination with the current standard hepatitis C treatment, pegylated interferon and ribavirin.
The European Medicines Agency recommended boceprevir (Victrelis) for approval.
Clinical trials showed that 79% of patients had their hepatitis C infection cured when they took the drug in combination with pegylated interferon and ribavirin.
Its side-effects include anaemia, tiredness and headache.
US authorities have approved telaprevir (Incivek). It also performed well in clinical trials when combined with pegylated interferon and ribavirin.
However, it can cause a serious rash, and people who develop this side-effect need to stop treatment with the drug.
These drugs were tested on people with hepatitis C monoinfection. Less is known about their safety and effectiveness in people who are co-infected with HIV and hepatitis C.
It’s often difficult to treat hepatitis C in co-infected patients, so there is hope that these new protease inhibitors will provide important new treatment options for co-infected patients. However, there’s still uncertainty about the best way to use them.
HIV care – online HIV clinic
The research was conducted in Barcelona and involved patients whose HIV infection was stable.
Doctors were concerned that increases in the numbers of HIV-positive patients were placing a strain on clinics.
Visits for routine appointments can also be inconvenient for patients. They usually involve seeing a doctor, nurse and pharmacist and can last up to two hours.
Therefore researchers wanted to see if care could be delivered effectively and safely via an online ‘Virtual Hospital.’
Patients had an online consultation with their doctor and pharmacist, and medicines were mailed directly to their home address.
Other healthcare professionals, such as psychologists, were also available to give online support.
Outcomes for patients using the Virtual Hospital were just as good as those for patients using traditional clinic services.
Some patients safely started or changed HIV treatment using online support.
The Virtual Hospital was rated as satisfactory, and its running costs were quite low.
Online support looks like a promising development as one element of HIV care.
Many patients in the UK already keep in contact with their doctor using email, and it can save time (and money for the NHS) to have home delivery of your anti-HIV drugs.