HIV treatment – once-daily nevirapine

A new formulation of nevirapine that is taken just once daily has been approved in the US.

Called Viramune XR, its daily dose consists of a single 400mg pill that can be taken with or without food.

The current standard nevirapine dose is 200mg twice daily.

Patients who start treatment with Viramune XR will need to take a 14-day lead-in dose of 200mg of immediate release nevirapine in order to reduce the risk of rash, a common side-effect during the first few weeks of nevirapine treatment.

However, it’s safe for patients who are already taking nevirapine to switch to the new once-daily pill.

Men with CD4 counts above 400 cells/mm³ and women with CD4 counts above 250 cells/mm³ should not start treatment with nevirapine. This is because of a risk of developing serious liver problems.

HIV and hepatitis B – vaccination

Patients with a high CD4 cell count can have an accelerated course of vaccinations against hepatitis B.

Research showed that the protection offered by a three-week vaccination schedule was equal to that provided by the standard six-month course of injections.

Hepatitis B can cause serious liver disease. It can be transmitted in the same ways as HIV. Everyone with HIV should be vaccinated against hepatitis B.

It’s necessary to have three doses of the vaccination, and these are usually administered over a six-month period.

But not everyone completes this schedule, meaning that they are not properly protected against the infection.

Therefore Dutch researchers wanted to see if a faster vaccination schedule – over three weeks – was safe and effective.

Overall, they found that a larger proportion of patients given the vaccine over six months developed protective antibodies against hepatitis B.

The researchers then restricted their analysis to patients with a CD4 cell count over 500.

This showed the three-week vaccination schedule was as effective as the standard six-month course of injections.

Vaccinations against hepatitis B are available for free from HIV and sexual health clinics. Your routine HIV care will involve tests to check the health of your liver and to see if you need a booster dose of the vaccine.

HIV and hepatitis B – treatment

A combination of Truvada with entecavir is a safe and effective option for patients co-infected with HIV and hepatitis B whose current anti-hepatitis B therapy is not working.

A number of drugs are available to treat hepatitis B. Some of these also work against HIV, so - if they are used inappropriately - this can lead to the development of drug-resistant strains of HIV.

Treatment guidelines recommend that HIV/hepatitis B-co-infected patients should start antiretroviral therapy when their CD4 cell count is between 350 and 500 and should take a combination of drugs that is based on tenofovir (Viread) with either FTC (emtricitabine, Emtriva, also combined with tenofovir in Truvada) or 3TC (lamivudine, Epivir). These drugs work against both viruses.

It’s already known that entecavir, an antiviral drug, is an effective option for patients who are only infected with hepatitis B.

However, little is known about the safety and effectiveness of the drug in co-infected patients who are also taking Truvada.

Researchers therefore studied 13 patients with both HIV and hepatitis B, whose current hepatitis B treatment wasn’t working.

All were taking HIV treatment that included Truvada and a protease inhibitor. They were also given entecavir to treat their hepatitis B.

The patients were monitored for a year and a half. Over a third experienced a fall in their hepatitis B viral load to undetectable levels, and liver function improved in two-thirds of patients.

Entecavir appeared safe, and no side-effects associated with the drug were reported.

HIV and hepatitis C – HIV treatment

Patients with both HIV and hepatitis C who have liver cirrhosis can safely take atazanavir (Reyataz) as part of their HIV treatment.

Atazanavir generally causes only mild side-effects. However, it can cause increases in bilirubin, and this can lead to the development of non-dangerous jaundice, or yellowing of the skin and eyes.

The drug’s standard dose is 300mg once a day. It is usually boosted by a 100mg dose of ritonavir (Norvir).

Little is known about the safety and effectiveness of atazanavir when it is used to treat patients co-infected with HIV and hepatitis C who have liver cirrhosis – permanent scarring of the liver.

To study this, Spanish researchers monitored 34 co-infected patients.

All the patients had experience of HIV treatment and switched to atazanavir. Three-quarters took the drug with the ritonavir booster.

Atazanavir treatment was well tolerated, and only six patients stopped taking the drug.

There were only mild increases in bilirubin, and treatment with the drug did not lead to a worsening of liver disease.

Therapy was highly successful against HIV – after a year 79% of patients had an undetectable viral load and 80% had a CD4 cell count over 200.