HIV vaccine found to be partially effective

By far the biggest HIV story in the past seven days was the publication of the results of a trial showing that, for the first time, an HIV vaccine was partially effective.

A combination of two vaccines lowered the rate of HIV infections by just over 30% compared to the placebo.

The results were surprising because both of the vaccines used in the study had previously been shown to be ineffective.

The study was conducted in Thailand and enrolled 16,000 people who were randomly selected to receive either the two vaccines or a dummy placebo.

Results showed that 74 people who received the placebo became infected with HIV compared to 51 people who were given the vaccine.

There’s cautious optimism that the results could lead to further breakthroughs in vaccine research.

But others are urging caution, pointing out that the apparent effectiveness of the vaccine rests on a very small number of infections, meaning that the results could just have been down to chance.

Further results from the study will be presented to a conference on HIV vaccines in October.

The vaccines used in the study have no treatment benefit for people with HIV.

Depression and adherence

People who develop depression whilst taking HIV treatment are less likely to take their HIV treatment properly – often called adherence -  than people who do not develop the condition, US researchers have found.

HIV treatment can mean a longer and healthier life, but it needs to be taken very rigorously to work properly. The best results are seen in people who take all or nearly all of their doses.

Many people with HIV experience mental health problems such as depression, and this has been associated with poorer adherence to HIV treatment.

US researchers have now found that people who develop depression when taking anti-HIV drugs are less likely to adhere properly.

Their research involved 225 people who had their adherence and mental health monitored at four consecutive clinic visits.

They found that a third of people who developed depression had adherence below the target 95% compared to 19% of those who did not develop depression.

The researchers recommend that there should be “ongoing screening for and attention to depression among women and men with HIV infection.”

A lot of support is available from your HIV clinic to help you adhere to treatment. It makes good sense to tell a member of your healthcare team if you are worried about your mental health. They can offer advice and help.

Treatments such as anti-depressants, counselling and other forms of psychological therapy are as effective in people with HIV as the general public.

There is more information on adherence in NAM’s new patient information booklet Adherence & resistance. You can download it here, or order it from our online bookshop.

HIV and cancer

Infections and smoking increase the risk of some cancers not normally considered to be HIV-related in people with HIV, an analysis of 13 separate studies has shown.

Kaposi’s sarcoma, non-Hodgkin’s lymphoma and cervical cancer are AIDS-defining cancers because they develop when a person with HIV’s immune system is weakened.

But evidence is accumulating that people with HIV also have increased rates of some other cancers.

Researchers examined the results of 13 studies looking at rates and risk factors of non-HIV-related cancers in people with HIV. These results compared the risk of these cancers in people with HIV to the risk in HIV-negative people.

Overall, people with HIV were twice as likely to develop cancer than HIV-negative people.

The most common cancers were lung cancer, Hodgkin’s lymphoma and anal cancer.

Many of the cancers that were more common in people with HIV were linked to infections. For example, anal cancer is caused by certain strains of the genital wart virus, the underlying cause of liver cancer is often hepatitis B or C, and Hodgkin’s lymphoma is caused by Epstein Barr virus.

Rates of cancers of the lung, mouth and throat – which are linked to cigarette smoking – were also elevated in people with HIV.

The researchers recommend that further studies should be conducted to see if people with HIV really do have an increased risk of certain cancers. Or, as the results of their analysis suggests, the increased rates of some cancers are down to infections that could be prevented, or behaviours such as smoking, that could be modified.

Efavirenz and side-effects

A study has shown that doses of efavirenz (Sustiva, also in the combination pill Atripla) can be safely reduced in people with high blood concentrations of the drug who are experiencing side-effects such as sleep and mood problems.

Efavirenz is a very popular anti-HIV drug and is recommended for people starting HIV treatment for the first time.

The drug has a very powerful anti-HIV effect, is easy to take and usually doesn’t cause very serious side-effects.

However, some people experience problems such as difficulty sleeping, vivid dreams, nightmares, a feeling of “being out of it” or depression, especially in the first weeks after starting the drug. In most people these side-effects fade as the body gets used to the drug, but in others they are longer-lasting and problematic.

Dutch researchers conducted a study lasting one year to see if the dose of efavirenz could be safely reduced in patients with high blood concentrations of the drug (above 4 mg/l).

All 180 patients in the study had their efavirenz levels monitored using a technique called therapeutic drug monitoring.

The daily dose of efavirenz was reduced from the standard 600mg to 400mg in the first instance in 47 patients, and some patients had further dose reductions.

All the patients who reduced their dose of efavirenz maintained blood concentrations that were high enough to effectively fight HIV and viral load remained undetectable.

Fewer patients who reduced their dose discontinued their efavirenz treatment than did patients who stayed on the full dose.

“Our study demonstrates that therapeutic drug monitoring-guided dose reduction can be considered in patients who have high efavirenz…concentrations. Dose reduction does not negatively affect virological efficacy and may prevent toxicity-induced discontinuations”, conclude the researchers.

You can find out more about ways of dealing with side-effects in NAM’s booklet Side-effects; you can download it here, or order it from our online bookshop .

HIV and TB

People with HIV who have latent tuberculosis (TB) should be given preventive TB treatment, UK researchers recommend.

TB is the biggest single cause of illness and death in people with HIV around the world, especially in Africa, and is one of the most common AIDS-defining illnesses seen in the UK. Although a person may not feel ill because of TB, the TB germ can remain alive within this contained area for many years, even decades, causing illness at a later time. This type of TB is usually called latent TB.

UK HIV guidelines don’t currently make any recommendations concerning screening for active or latent TB, nor do they make recommendations about the use of preventive TB treatment.

Therefore researchers looked at the rate of TB amongst HIV patients in the UK over a ten-year period. They also studied the characteristics of patients developing TB.

About 3% of the 23,000 patients in the study developed TB. The disease was much more common in patients from Africa than it was in white patients, and also particularly affected patients with a low CD4 cell count.

TB was rare in patients who had been taking HIV treatment for three months or more. But the researchers noticed that the number of TB cases in Africans was still high two years after they had started HIV treatment.

The researchers recommend that in addition to starting HIV treatment, “HIV clinics should screen new patients for active TB, implement infection control measures, and offer tuberculosis preventative therapy, particularly to migrants from settings of high tuberculosis prevalence”.

They also recommend that “individuals with evidence suggesting latent tuberculosis infection should be targeted for preventative therapy.”

You can find out more in NAM’s booklet HIV & TB; you can download it here, or order it from our online bookshop.

Deportation of migrants with HIV sometimes contravenes human rights

A report by a human rights agency has found that the deportation of HIV-positive migrants often violates international human rights agreements.

Human Rights Watch said that it was important that migrants had access to HIV treatment whilst being detained and awaiting deportation, and that they were able to continue to access HIV treatment and care after their deportation.

The UK charity the African HIV Policy Network was one of the co-authors of the report. A representative of AHPN noted that many of the situations across the world highlighted in the report had parallels in the UK.

A good first place for information and advice about the rights of migrants with HIV in the UK is the helpline run by the Terrence Higgins Trust - THT Direct. You can contact THT Direct on 0845 12 21 200.