HIV treatment – d4T should only be used as a last resort
Medicines regulators in Europe have issued guidance about the use of the anti-HIV drug d4T (stavudine, Zerit). This warns that the drug should only be used if there are no other treatment options.
It is now well-known that d4T can cause a number of serious side-effects. These include:
- Neuropathy – painful damage to the nerves in the feet, legs and hands.
- Lipodystrophy – especially fat loss from the face, limbs and buttocks.
- Lactic acidosis – a build up of lactic acid in the body, which can be fatal if not appropriately treated.
If d4T is used, the guidance stresses that this should be for the shortest possible time.
Routine use of d4T was abandoned in the UK several years ago when studies confirmed its association with serious side-effects.
Although the drugs used in routine HIV treatment today can cause side-effects, these are usually mild and short-lived, especially in comparison to those caused by d4T.
In 2009 the World Health Organization (WHO) recommended phasing out use of d4T. However, d4T remains a mainstay of HIV treatment in many resource-limited countries, chiefly because of its low cost.
HIV treatment – statin use reduces immune activation
US researchers found that treatment with the drug reduced levels of immune activation in HIV-positive patients. Immune activation has been linked to a higher risk of cardiovascular disease for people with HIV and to poorer CD4 cell gains on treatment.
The 22 patients in the study were treated with a once-daily 80mg dose of atorvastatin or a placebo.
None of the patients in the study were taking HIV treatment.
There was no evidence that statin therapy reduced viral load or increased CD4 cell count.
But the researchers did find that the drug lowered some key markers of immune activation. It’s already known that statins have an anti-inflammatory effect, and this could explain the finding.
The researchers think the results of their study suggest that statins could have a useful role in HIV therapy. This is especially because many people with HIV also have increased cholesterol or other risk factors for cardiovascular disease.
Separate research suggested that atorvastatin was one of the statins that had the biggest impact on cholesterol levels in people with HIV.
But the study had some important limitations. It only included 22 people, and they only received statins for four weeks. So much larger and longer studies will be necessary to see if treatment with this type of drug really does have any anti-HIV effect.
HIV and liver disease
Liver disease is now an important cause of illness and death in people with HIV. It mainly occurs in patients who are co-infected with hepatitis B or hepatitis C (or, in some cases, both).
All HIV-positive patients should have the health of their liver checked regularly, as part of a routine check-up.
However, if liver damage, or fibrosis, is suspected, it’s usually been necessary for a patient to have a liver biopsy. This involves the removal of a small sample of liver tissue in a minor procedure.
But researchers looking at liver function in women with, or at risk of, HIV have now found that three simple blood tests and consideration of the results of these in relation to a patient’s age can accurately show if a patient has liver damage.
Two of the blood tests look at markers of liver function, and the other measures levels of platelets which help the blood clot. These simple four processes could have a useful role in HIV care, and help guide treatment decisions.
Unsurprisingly, co-infection with hepatitis C was associated with poorer liver health. But results also showed that a low CD4 cell count and a higher HIV viral load were also associated with poorer liver function. The researchers speculate that HIV itself could be damaging liver function.