New drug approved in US
A new NNRTI has been approved in the US. It is called etravirine (TMC 125, Intelence). Importantly, it works against strains of HIV that have developed resistance to the existing NNRTIs (efavirenz, Sustiva and nevirapine, Viramune).
Etravirine needs to be used in combination with other anti-HIV drugs and its use is reserved for people who’ve taken anti-HIV treatment before and have a detectable viral load with evidence of resistance to the existing NNRTIs.
Rash and feeling sick are the side-effects most frequently associated with etravirine.
But etravirine won’t work for everybody. If a person has a lot of resistance to NNRTIs then etravirine probably isn’t an option. And the drug should not be taken with other NNRTIs, many of the ritonavir-boosted protease inhibitors, and some other important medicines, such as rifampicin and rifabutin, key tuberculosis drugs.
At the moment etravirine is only available in the UK and Europe as part of an expanded access scheme but full approval is expected later in 2008.
The immune system
Viral load and infectiousness
The goal of anti-HIV treatment is an undetectable viral load in the blood.
Anti-HIV treatment can also have an effect on viral load in other bodily fluids, such as sexual fluids.
But some doctors and health educators are concerned that people with HIV may believe that having an undetectable viral load in blood means that they are uninfectious and therefore have risky sex.
Researchers wanted to see if there was a link between the level of viral load in blood and semen. They looked at studies that have investigated this.
They found that the levels of HIV in blood and semen are connected. On the plus side, people who took their HIV treatment properly had undetectable viral load in both their blood and semen. But sometimes, men had a higher viral load in their semen than their blood. This was most likely to happen when a man had an untreated sexually transmitted infection such as gonorrhoea.
The researchers argue that semen with an undetectable viral load may still be infectious, and that cells in semen can contain HIV proviral DNA that can act “as vehicles for sexual transmission of HIV.”
HIV, gay men and MRSA
Reports in some newspapers suggested that this MRSA strain was a sexually transmitted superbug, even a “new HIV.” These reports were picked up by some anti-gay groups in America.
The CDC issued a statement saying “MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including sex. There is no evidence at this time to suggest that MRSA is a sexually transmitted infection in the classical sense.”
And the UCSF issued a statement expressing regret about the way the findings of the study had been interpreted.
One of the study’s authors, Dr Henry Chambers, told the US magazine, Newsweek, which ran a major story about the study, entitled “A new gay disease?” that “this is definitely not the new AIDS.”
HIV and stigma
As the item above shows, HIV and the communities affected by it are often stigmatised.
Sometimes this stigma comes from healthcare workers and US researchers asked HIV-positive men about their experiences of stigma in healthcare.
Some of the men didn’t report any stigma. But many men reported that healthcare workers behaved differently to them because they had HIV. In some case the men received poorer treatment and care because of their HIV.
You can find out more about this subject in the NAM booklet, HIV and Stigma.