HIV treatment – darunavir works well in treatment-experienced patients

There have been some big improvements in HIV treatment and care in recent years. Thanks to these, the aim of treatment for most patients is an undetectable viral load.

An important treatment option for those who have a lot of experience of HIV therapy is the protease inhibitor darunavir (Prezista).

Its power is boosted by taking it with a small dose of a second protease inhibitor called ritonavir (Norvir).

Clinical trials showed that including darunavir in an HIV treatment option was safe and effective in very treatment-experienced patients. The best results are seen when it’s combined with other drugs that work against HIV. Darunavir has also been approved for people starting HIV treatment for the first time.

But people in clinical trials usually receive a lot of support and are intensively monitored. Drugs don’t always have such good results when used in routine HIV care.

Researchers therefore wanted to see how effective darunavir was at suppressing viral load in 130 treatment-experienced Swiss patients who had received the drug as part of their HIV therapy.

The patients had taken a lot of anti-HIV drugs in the past. Many had HIV with some form of resistance to darunavir.

However, after a year of treatment, viral load was undetectable in 80% of patients. This compared to 45% in clinical trials. Having a detectable viral load was associated with poor treatment adherence, and with previous treatment with the protease inhibitors fosamprenavir or amprenavir (Agenerase or Telzir) and saquinavir (Invirase).

The drug was safe – only a small number of patients stopped taking it because of side-effects.

Read the full news story on our website here or visit the journal website to view the original article here.

HIV treatment – saquinavir side-effect warning

All medicines – including those used to treat HIV – can cause side-effects.

Some protease inhibitors have been associated with an irregular heartbeat. It’s already known that this is the case with saquinavir/ritonavir.

Now drug regulatory authorities in both the US and Europe have issued a strengthened warning about the heart rhythm disturbances that can be caused by ritonavir-boosted saquinavir (Invirase).

Although this side-effect is rare, it’s now recommended that all patients should have an ECG examination to monitor the health of their heart before they start treatment with saquinavir.

Medicine regulators in the US have also made specific recommendations about heart rhythm and treatment with saquinavir.

They recommend that anyone taking the drug should: “Seek immediate care if you experience an abnormal heart rate or rhythm or other symptoms including dizziness, lightheadedness, fainting or heart palpitations.”

European regulators have also made specific recommendations about saquinavir doses for those starting HIV treatment for the first time.

These state that the dose of saquinavir for the first week of treatment will be reduced from 1000mg twice daily to 500mg twice daily. This dosage adjustment is not necessary in patients who are switching from other antiretroviral drugs; the European Medicines Agency says the risk of an irregular heartbeat is greatest in people who have never taken antiretroviral drugs before.

For more information on side-effects you can read our information booklet on our website here.

HIV and sexual health – treatment of syphilis

High rates of sexually transmitted infections, including syphilis, have been seen in people with HIV.

Syphilis is a bacterial infection which can cause serious health problems if left untreated.

However, it can be successfully treated with antibiotics.

The usual treatment is injections into the muscle (usually the buttocks) of a long-lasting form of penicillin called benzathine penicillin G. Other antibiotics also work against syphilis.

The intensity of treatment varies according to the stage of syphilis – for example patients with syphilis that’s affecting the brain (neurosyphilis) are treated with a different type of penicillin that’s administered intravenously.

There have been reports of the standard treatments for syphilis not working as well in people with HIV. Because of this some doctors are uncertain about the best way to treat the infection.

US guidelines say that HIV-positive patients with syphilis should receive the standard therapies but with more intensive follow-up.

But a team of researchers have found that this recommendation has a very poor evidence base.

They could only find 23 studies that provided an in-depth analysis of syphilis therapy for patients with HIV. Only two of these studies were ranked as high quality.

Reported treatment failure rates were as high as 22% for early syphilis, 31% for latent syphilis and 28% for neurosyphilis. These rates are much higher than the 3 to 10% seen in HIV-negative patients.

The researchers don’t rule out the possibility that standard syphilis therapy is less effective in patients with HIV. But they think it’s more likely that there are other reasons for the high failure rate in these studies, for example, reinfection with syphilis.

There’s more information on syphilis and its treatment in our HIV Treatments Directory, now available on our website here.