Anti-HIV treatment

Raltegravir available in the UK

Raltegravir (Isentress) is now available in the UK.

It belongs to a new class of anti-HIV drugs called integrase inhibitors. It works against a protein that HIV uses to integrate into key CD4 immune system cells.

 The drug is an important treatment option for people who’ve taken a lot of anti-HIV drugs in the past and have a lot of drug-resistant HIV. But it’s also hoped that raltegravir will eventually be a good option for people starting anti-HIV treatment.

 Raltegravir’s dose is 400mg twice a day. Its main side-effects are diarrhoea, feeling sick, and headache.

Kaletra by itself

Effective anti-HIV treatment normally consists of three different anti-HIV drugs that come from  two separate classes of antiretrovirals (each class of antiretrovirals work against HIV in a slightly different way). Using anti-HIV drugs in this way means that they have a very powerful effect against the virus. And if they are taken properly, it is difficult for HIV to develop resistance to them, meaning that they should work against HIV for a very long time.

Some people find it difficult to take a number of different drugs properly, and taking multiple drugs can involve a risk of side-effects. So doctors wanted to see if Kaletra (lopinavir/ritonavir), a powerful protease inhibitor, could be safely and effectively used as anti-HIV treatment by itself.

Two studies looking at this have recently been published. And they have conflicting results.

A French study divided 136 people starting anti-HIV treatment for the first time to either take a traditional anti-HIV treatment combination consisting of Kaletra and Combivir (AZT and 3TC) or just Kaletra by itself. The compared how many patients on the two different treatments had an undetectable viral load after a year.

They found that only 64% of patients who only took Kaletra had an undetectable viral load at this time compared to 75% of people who took the three drug combination.

But a Spanish study produced different results. It included 205 people, all of whom had already experienced a fall in their viral load to undetectable levels using traditional three drug anti-HIV treatment that included Kaletra. They were then divided to either continue with their three drug treatment including Kaletra, or to switch to treatment with just Kaletra.

After a year, more or less equal numbers of people taking both types of treatment had an undetectable viral load (triple drug treatment, 90%, Kaletra by itself, 85%).

Treatment for people with a lot of drug-resistant HIV

HIV can develop resistance to anti-HIV drugs and because of this some people have HIV that is very difficult to treat.

Doctors have two approaches to treating people in this situation. Sometimes they stop anti-HIV treatment completely in the hope that HIV that isn’t drug-resistant will start to multiply. This virus will then be sensitive to antiretroviral drugs when treatment is started again. Or they continue treatment, often adding in more drugs.

French doctors have found that people with lots of resistance, and few effective drug options available, who continue to take their HIV treatment are less likely to become seriously ill than people in this situation who stop their treatment.

New AIDS-defining illness occurred much more frequently in people who stopped treatment than those who carried on taking their anti-HIV drugs.

But doctors are hopeful that the careful use of the new anti-HIV drugs maraviroc and raltegravir, which work against HIV in a different way to existing antiretrovirals, will mean that they have a good chance of controlling HIV in people with a lot of drug resistance.

Side-effects

Heart disease

Anti-HIV drugs can cause long-term side-effects, and there is now good evidence that some anti-HIV drugs can increase blood fats meaning that there’s a risk of developing heart disease in the future.

People taking anti-HIV treatment should have levels of their blood fats regularly checked and need to report symptoms like chest pains to their doctors.

But the early stages of heart disease sometimes don’t have symptoms, and American researchers have found that 15% of people with HIV have narrowing of the arteries that carry blood to the heart.

A quarter of people who were taking anti-HIV treatment had this condition compared to 7% of those not taking anti-HIV drugs.

But the researchers found that the real risks for narrowing of the coronary arteries were traditional risk factors for heart disease, such as smoking, and long-term use of the drug cocaine. In fact, they thought that only 1.6% of cases of narrowing of the coronary arteries were due to anti-HIV treatment.

You can reduce your risk of heart disease by exercising regularly, eating a good diet with lots of fresh fruit and vegetables and not too much fat, and by not smoking.

HIV and hepatitis C virus

Cannabis use and liver disease

Hepatitis C virus can cause serious, even fatal, damage to the liver. Many people with HIV are also infected with hepatitis C. They are often said to have HIV/hepatitis C virus coinfection.

Hepatitis C causes liver damage more rapidly in people with HIV. Treatment is available for hepatitis C, but it doesn’t have very good results in people with HIV.

American researchers have found that people with HIV/hepatitis C coinfection who smoked the recreational drug cannabis every day had worse liver damage than people who didn’t use the drug at all, or who used it infrequently.

In the study, people with HIV were more likely than those who just had hepatitis C to be regular users of cannabis and to use cannabis for medicinal purposes.

There’s evidence that livers severely damaged by hepatitis or heavy drinking are more likely to be affected by the active part of cannabis – cannabinoids.

The researchers therefore suggest that it is especially important for people with HIV/hepatitis C coinfection to avoid regular cannabis use.

HIV and children

New Kaletra tablet close to approval

A new Kaletra tablet for children has taken a key step towards formal approval in the UK and Europe.

The new tablet contains 100mg of lopinavir and 25mg of ritonavir, half the standard adult dose. It is expected to be fully approved in the next three months.